# GATES RAPID DIAGNOSTIC LABORATORY OF ATLANTA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710284435
- **Authorized official:** DR. JACKSON L. GATES M.D (OWNER)
- **Authorized official phone:** (678) 591-6509

## Contact information

- **Practice address:** 777 CLEVELAND AVE SW, SUITE 100, ATLANTA, GA 30315-7129
- **Practice address phone:** (404) 763-0093
- **Mailing address:** 1880 LANCASTER DRIVE, CONYERS, GA 30013
- **Mailing address phone:** (678) 591-6509

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 038767 | GA | Yes |

## Other

- **Enumeration date:** 02/15/2011
- **Last updated:** 02/15/2011