Newstar Medical Laboratories, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

NEWSTAR MEDICAL LABORATORIES, LLC

Practice address

975 Cobb Place Blvd NW Ste 218
Kennesaw, GA 30144-4802

Phone

(678) 505-8016

Fax

(678) 806-7192

NPI assigned

Feb 28, 2018

Organization subpart

No

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

Authorized official

Name

Raymond Godwin

Title

Ceo

Phone

(678) 505-8016

Specialties & licenses 1

Addresses

Other identifiers 3

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Omega Molecular Laboratories LLC

  • Clinical Medical Laboratory
  • Alpharetta, GA
  • NPI 1124890934

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1519776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1962903575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "975 COBB PLACE BLVD NW STE 218",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301444802",
            "telephone_number": "678-505-8016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 COBB PLACE BLVD NW STE 218",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301444802",
            "telephone_number": "678-505-8016",
            "fax_number": "678-806-7192"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3238 S Fair Ln",
            "address_purpose": "LOCATION",
            "city": "Tempe",
            "state": "AZ",
            "postal_code": "852823120",
            "country_code": "US",
            "telephone_number": "678-505-8016",
            "fax_number": "678-806-7192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NEWSTAR MEDICAL LABORATORIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-28",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "GODWIN",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-505-8016"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146207500",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003211136A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "222806",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Linda Nguyen
• Ebony Niblack

• Clinical Medical Laboratory in Kennesaw, GA
• Providers in Kennesaw, 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 14, 2022; 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.