Organization
SOUTHERN CLINICAL LABORATORY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAVINDER C REDDY MS (PRESIDENT)
(770) 513-4140
Entity
Organization
Contact information
Practice address
405 W PIKE ST, SUIET A, LAWRENCEVILLE, GA 30046-4845
(770) 513-4140
(770) 682-9529
Mailing address
405 W PIKE ST, SUIET A, LAWRENCEVILLE, GA 30046-4845
(770) 513-4140
(770) 682-9529
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
067-025
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000494535A
—
GA
Enumeration date
08/01/2006
Last updated
07/06/2011
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