Active NPI
Salvuslabs LLC
- Clinical Medical Laboratory
- Marietta, GA
National Provider Identifier
1083018295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- License
- 11D2084569
- Legal business name
- SALVUSLABS LLC
- Practice address
- 200 Cobb Pkwy N Ste 124
Marietta, GA 30062-3538 - Phone
- (678) 738-1999
- Fax
- (678) 236-0916
- NPI assigned
- Oct 17, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Charlotte A Hymel
- Title
- Ceo
- Phone
- (678) 738-1999
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | 11D2084569 | GA | Primary |
Addresses
Primary practice location
200 Cobb Pkwy N Ste 124
Marietta, GA 30062-3538
Mailing address
200 Cobb Pkwy N Ste 124
Marietta, GA 30062-3538
Phone (678) 738-1999
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11D2084569 | Other | GA | CLIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150304002366 | GA | Part B Supplier - Independent Clinical Laboratory | 5991021222 | Practice locations: Marietta, GA |
National Provider Directory
National Provider DirectoryLocations
200 Cobb Pkwy N
Ste 100
Marietta, GA 30062
200 Cobb Pkwy N
Ste 124
Marietta, GA 30062
Phone (678) 738-1999
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413504000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1594857600000",
"number": "1083018295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 COBB PKWY N STE 124",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300623538",
"telephone_number": "678-738-1999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 COBB PKWY N STE 124",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300623538",
"telephone_number": "678-738-1999",
"fax_number": "678-236-0916"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SALVUSLABS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2014-10-17",
"last_updated": "2020-07-16",
"certification_date": "2020-07-16",
"status": "A",
"authorized_official_last_name": "HYMEL",
"authorized_official_first_name": "CHARLOTTE",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "678-738-1999"
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": "GA",
"license": "11D2084569",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLIA",
"identifier": "11D2084569",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.