Organization Name: | GATES RAPID DIAGNOSTIC LABORATORY OF ATLANTA |
NPI Number: | 1710284435 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JACKSON L. GATES (OWNER) |
Mailing Address: | 777 Cleveland Ave Sw Suite 100 Atlanta |
State: | GA US |
Postal Code: | 303157129 |
Phone Number: | 4047630093 |
Fax Number: | |
NPI Enumeration Date: | 02/15/2011 |
NPI Last Update Date: | 02/15/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 038767 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |