Provider Demographics
NPI:1891216628
Name:EXPRESS MEDICAL LAB LLC
Entity type:Organization
Organization Name:EXPRESS MEDICAL LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:
Authorized Official - Credentials:ASCP
Authorized Official - Phone:678-704-5656
Mailing Address - Street 1:1200 HIGHWAY 74 S STE 3
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3071
Mailing Address - Country:US
Mailing Address - Phone:678-704-5656
Mailing Address - Fax:
Practice Address - Street 1:1200 HIGHWAY 74 S STE 3
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3071
Practice Address - Country:US
Practice Address - Phone:678-704-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty