Organization
MED-LAKE LABORATORY, LLC
Active
Organization
MED-LAKE LABORATORY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER MOSS (BILLING MANAGER)
(478) 414-4235
Entity
Organization
Contact information
Practice address
100 INDUSTRIAL PARK RD NW, MILLEDGEVILLE, GA 31061-6602
(478) 454-6696
Mailing address
100 INDUSTRIAL PARK RD NW, MILLEDGEVILLE, GA 31061-6602
(478) 454-6696
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003221539A
—
GA
Enumeration date
11/15/2018
Last updated
03/03/2023
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