Organization
METAMARK LABORATORIES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SATHISH KOTHANDARAM (PRESIDENT & C.E.O)
(855) 420-8243
Entity
Organization
Contact information
Practice address
985 BROAD ST., SUITE A, AUGUSTA, GA 30901-1286
(877) 743-3338
Mailing address
985 BROAD ST., AUGUSTA, GA 30901-1286
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
121-058
GA
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE3909
RR MEDICARE
GA
Enumeration date
08/14/2006
Last updated
10/08/2017
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