NPIMap

Organization Active NPI

360 Laboratories, LLC

  • Clinical Medical Laboratory
  • Norcross, GA
National Provider Identifier
1871024273
Registry record updated Sep 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
067-078 Issued in GA
Legal business name
360 LABORATORIES, LLC
Practice address
1180 Beaver Ruin Rd
Suite a
Norcross, GA 30093-6801
Phone
(678) 235-4212
Fax
(678) 399-3659
NPI assigned
Mar 27, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2019

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

Authorized official

Name
Fadi Elkhatib
Title
Owner
Phone
(770) 617-6060

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 067-078 GA Primary

Addresses

Primary practice location

1180 Beaver Ruin Rd
Suite a
Norcross, GA 30093-6801

Mailing address

1180 Beaver Ruin Rd
Suite a
Norcross, GA 30093-6801
Phone (678) 235-4212

National Provider Directory

National Provider Directory

Locations

1180 Beaver Ruin Rd
Ste A
Norcross, GA 30093
Phone (678) 235-4212

NPI Registry JSON

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

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568851200000",
    "number": "1871024273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 BEAVER RUIN RD",
            "address_2": "SUITE A",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300936801",
            "telephone_number": "678-235-4212",
            "fax_number": "678-399-3659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 BEAVER RUIN RD",
            "address_2": "SUITE A",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300936801",
            "telephone_number": "678-235-4212",
            "fax_number": "678-399-3659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "360 LABORATORIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-27",
        "last_updated": "2019-09-19",
        "status": "A",
        "authorized_official_last_name": "ELKHATIB",
        "authorized_official_first_name": "FADI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-617-6060"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "GA",
            "license": "067-078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norcross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2019; 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.