Medilab Diagnostics LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MEDILAB DIAGNOSTICS LLC

Practice address

6737 Bill Carruth Pkwy Apt 4311
Hiram, GA 30141-3779

Phone

(770) 370-8088

NPI assigned

Dec 2, 2021

Organization subpart

No

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

Authorized official

Name

Kanisha Johnson, BSN RNNPI 1528726080

Title

Owner/Administrator

Phone

(770) 370-8088

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kanisha Johnson, BSN RN

  • General Practice Registered Nurse
  • Hiram, GA
  • NPI 1528726080
  NPD Authorized official

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

{
    "created_epoch": "1638403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645488000000",
    "number": "1972261436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6737 BILL CARRUTH PKWY APT 4311",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301413779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6737 BILL CARRUTH PKWY APT 4311",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301413779",
            "telephone_number": "770-370-8088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDILAB DIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-02",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KANISHA",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "770-370-8088",
        "authorized_official_credential": "BSN RN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lyresa McGriff, LAPC
• Nicole Marie McHargue, MS, RN, CPNP
• Sherrie McKinnon
• Hu-Ann McNealy
• Regan Means, LPC
• Dana Melvin, PFT.
• Vanchad C Memark, M.D.
• Obger Mercier, GM
• Camarisk Merriweather, CNA
• Christine Min, MD

• Clinic/Center in Hiram, GA
• Providers in Hiram, GA by specialty
• Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 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.