Provider Demographics
NPI:1699861328
Name:LABMD INC
Entity type:Organization
Organization Name:LABMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-443-2330
Mailing Address - Street 1:2030 POWERS FERRY RD SE
Mailing Address - Street 2:SUITE 520
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2823
Mailing Address - Country:US
Mailing Address - Phone:678-443-2330
Mailing Address - Fax:678-443-2339
Practice Address - Street 1:2030 POWERS FERRY RD SE
Practice Address - Street 2:SUITE 520
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2823
Practice Address - Country:US
Practice Address - Phone:678-443-2330
Practice Address - Fax:678-443-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2009-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11D1016172291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00869217AMedicaid
GAP00229191OtherRAILROAD MEDICARE
GA69WBDLZMedicare PIN
GAP00229191OtherRAILROAD MEDICARE