Organization
GATES RAPID DIAGNOSTIC LABORATORY OF ATLANTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACKSON L. GATES M.D (OWNER)
(678) 591-6509
Entity
Organization
Contact information
Practice address
777 CLEVELAND AVE SW, SUITE 100, ATLANTA, GA 30315-7129
(404) 763-0093
Mailing address
1880 LANCASTER DRIVE, CONYERS, GA 30013
(678) 591-6509
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
038767
GA
Other
Enumeration date
02/15/2011
Last updated
02/15/2011
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