Provider Demographics
NPI:1730843251
Name:GCLAB LLC
Entity type:Organization
Organization Name:GCLAB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GERMANUS
Authorized Official - Middle Name:OKECHUKWU
Authorized Official - Last Name:EJIOGU
Authorized Official - Suffix:
Authorized Official - Credentials:B S M T
Authorized Official - Phone:770-692-1241
Mailing Address - Street 1:635 GLYNN STREET N.
Mailing Address - Street 2:SUITE 1 & 2
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214
Mailing Address - Country:US
Mailing Address - Phone:770-692-1241
Mailing Address - Fax:770-719-1443
Practice Address - Street 1:635 GLYNN STREET N.
Practice Address - Street 2:SUITE 1 & 2
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214
Practice Address - Country:US
Practice Address - Phone:770-692-1241
Practice Address - Fax:770-719-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-30
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory