Med-Lake Laboratory, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MED-LAKE LABORATORY, LLC

Practice address

100 Industrial Park Rd NW
Milledgeville, GA 31061-6602

Phone

(478) 454-6696

NPI assigned

Nov 15, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jennifer Moss

Title

Billing Manager

Phone

(478) 414-4235

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1542240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677801600000",
    "number": "1174092548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 INDUSTRIAL PARK RD NW",
            "city": "MILLEDGEVILLE",
            "state": "GA",
            "postal_code": "310616602",
            "telephone_number": "478-454-6696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 INDUSTRIAL PARK RD NW",
            "city": "MILLEDGEVILLE",
            "state": "GA",
            "postal_code": "310616602",
            "telephone_number": "478-454-6696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED-LAKE LABORATORY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-15",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-03",
        "status": "A",
        "authorized_official_last_name": "MOSS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "478-414-4235",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003221539A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jasmine Nia McKane, FNP-C
• John R McLaren, M.D.
• Shanavorn Deaundra McMullen, PT
• C Steve McQuaig, MD
• Charles Stephen McQuaig II, O.D.
• Med-Ride LLC
• Medical Arts Pharmacy
• Medical Kidney Services of Central Georgia, LTD.
• Sherry Ann Meeks, D.C.
• Bradley J Mell

• Clinical Medical Laboratory in Milledgeville, GA
• Providers in Milledgeville, GA by specialty
• Clinical Medical Laboratory in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.