Organization
ETL- NORTHEAST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN GOSS MD (OWNER)
(713) 819-6417
Entity
Organization
Contact information
Practice address
3610 DEKALB TECHNOLOGY PKWY STE 125, DORAVILLE, GA 30340-3607
(888) 451-4440
Mailing address
2566 SHALLOWFORD RD NE STE 104P367, ATLANTA, GA 30345-1249
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
06/11/2021
Last updated
06/11/2021
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