Organization
NEWSTAR MEDICAL LABORATORIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND GODWIN (CEO)
(678) 505-8016
Entity
Organization
Contact information
Practice address
975 COBB PLACE BLVD NW STE 218, KENNESAW, GA 30144-4802
(678) 505-8016
(678) 806-7192
Mailing address
975 COBB PLACE BLVD NW STE 218, KENNESAW, GA 30144-4802
(678) 505-8016
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003211136A
—
GA
05
—
146207500
—
MD
05
—
222806
—
AL
Enumeration date
02/28/2018
Last updated
03/14/2022
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