Organization
B & L MEDICAL LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUIS AURELIO RODRIGUEZ SR. M.D. (PRESIDENT)
(404) 371-8419
Entity
Organization
Contact information
Practice address
149 SYCAMORE ST, DECATUR, GA 30030-3338
(404) 371-8419
(404) 371-8314
Mailing address
149 SYCAMORE ST, DECATUR, GA 30030-3338
(404) 371-8419
(404) 371-8314
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
207ZP0102X
GA
291U00000X
Clinical Medical Laboratory
207ZP0102X
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00081573D
—
GA
01
—
265908119A
MEDICARE
GA
Enumeration date
01/24/2008
Last updated
01/24/2008
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