Excel Diagnostic Laboratory, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

033-109 Issued in GA

Legal business name

EXCEL DIAGNOSTIC LABORATORY, INC.

Practice address

2740 Jefferson St
Suite B
Austell, GA 30168-4014

Phone

(404) 219-0912

NPI assigned

Aug 26, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Eugene H. Russell III

Title

Technical Director

Phone

(404) 219-0912

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1472169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472169600000",
    "number": "1326594722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 JEFFERSON ST",
            "address_2": "SUITE B",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301684014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 JEFFERSON ST",
            "address_2": "SUITE B",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301684014",
            "telephone_number": "404-219-0912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEL DIAGNOSTIC LABORATORY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-26",
        "last_updated": "2016-08-26",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "TECHNICAL DIRECTOR",
        "authorized_official_telephone_number": "404-219-0912",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "GA",
            "license": "033-109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Austell, GA
• Providers in Austell, 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 Aug 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.