Laboratory South Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

044134 Issued in GA

Legal business name

LABORATORY SOUTH INC

Practice address

189 W Athens St
Winder, GA 30680-2295

Phone

(770) 270-9471

Fax

(770) 270-9470

NPI assigned

Oct 19, 2006

Organization subpart

No

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

Authorized official

Name

Mark T Springer

Title

Owner

Phone

(770) 270-9471

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1366524563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 330",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306770009",
            "telephone_number": "770-270-9471",
            "fax_number": "770-270-9470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 W ATHENS ST",
            "city": "WINDER",
            "state": "GA",
            "postal_code": "306802295",
            "telephone_number": "770-270-9471",
            "fax_number": "770-270-9470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORY SOUTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "SPRINGER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-270-9471"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "GA",
            "license": "044134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE ID NUMBER",
            "identifier": "320731",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP ID NUMBER",
            "identifier": "10066591",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "389117",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scott Timothy Kobsar, LMSW
• James Karl Krantz, RN
• Olga Kukharchuk, FNP-C
• Elena E. Kurz, DMD
• Stephanie Kutchback, NP
• Lacey Katelyn Lackey, DPT
• Sierra Larkin
• Michael Latella
• Danielle Lazenby
• Traci Reid Leak, MS, CCC,SLP

• Clinical Medical Laboratory in Winder, GA
• Providers in Winder, 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 20, 2008; 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.