Organization
LABORATORY SOUTH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK T SPRINGER (OWNER)
(770) 270-9471
Entity
Organization
Contact information
Practice address
189 W ATHENS ST, WINDER, GA 30680-2295
(770) 270-9471
(770) 270-9470
Mailing address
PO BOX 330, WATKINSVILLE, GA 30677-0009
(770) 270-9471
(770) 270-9470
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
044134
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10066591
AMERIGROUP ID NUMBER
GA
01
—
320731
WELLCARE ID NUMBER
GA
01
—
389117
BCBS PROVIDER NUMBER
GA
Enumeration date
10/19/2006
Last updated
04/20/2008
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