Envision Healthcare Resources, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

067-081 Issued in GA

Legal business name

ENVISION HEALTHCARE RESOURCES, LLC

Doing business as

Envision Clinical Laboratory

Practice address

629 Airport Rd
Suite C
Lawrenceville, GA 30046-4474

Phone

(770) 545-8877

NPI assigned

Apr 26, 2017

Organization subpart

No

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

Authorized official

Name

Mrs. Mikelle Coleby, MT(ASCP)

Title

President/Ceo

Phone

(678) 251-8180

Specialties & licenses 1

Addresses

Other names 1

• Envision Clinical Laboratory Doing business as

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": "1493164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714435200000",
    "number": "1285169359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 AIRPORT RD STE J",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464474",
            "telephone_number": "678-251-8180",
            "fax_number": "770-545-8840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 AIRPORT RD",
            "address_2": "SUITE C",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464474",
            "telephone_number": "770-545-8877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENVISION HEALTHCARE RESOURCES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-26",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A",
        "authorized_official_last_name": "COLEBY",
        "authorized_official_first_name": "MIKELLE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "678-251-8180",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MT(ASCP)"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "GA",
            "license": "067-081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Envision Clinical Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Lawrenceville, GA
• Providers in Lawrenceville, 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 Apr 30, 2024; 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.