PEACHSTATE HEALTH MANAGEMENT LLC (AEON CLINICAL LABORATORIES) - NPI NUMBER 1972888139

Summary

Provider Name: PEACHSTATE HEALTH MANAGEMENT LLC (AEON CLINICAL LABORATORIES)

NPI Number: 1972888139

Clasification: Clinical Medical Laboratory (291U00000X)

Address:
2225 CENTENNIAL DR
GAINESVILLE, GA
ZIP 30504

Phone Number: (678) 276-8411



Detailed Information

PEACHSTATE HEALTH MANAGEMENT LLC is a clinical medical laboratory in Gainesville, GA. The provider is (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. The assigned NPI number for this provider is 1972888139 and is registered as an organization entity type.
The provider Is Doing Business As Aeon Clinical Laboratories.

The provider's business address is:

2225 CENTENNIAL DR
GAINESVILLE, GA
ZIP 30504-760
Phone: (678) 276-8411
Fax: (678) 971-4830

The provider's authorized official is Shawn Desai .
The authorized official title is Lab Operations Manager and has the following contact phone number (678) 276-8411.

The enumeration date for this NPI number is 10/19/2011 and was last updated on 11/14/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 291U00000X Clinical Medical Laboratory Yes

NPI Record

No. Field Name Field Value
1 NPI 1972888139
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name PEACHSTATE HEALTH MANAGEMENT LLC
5 Provider Other Organization Name AEON CLINICAL LABORATORIES
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 2225 CENTENNIAL DR
8 Provider Business Practice Location Address City Name GAINESVILLE
9 Provider Business Practice Location Address State Name GA
10 Provider Business Practice Location Address Postal Code 305045760
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 6782768411
13 Provider Business Practice Location Address Fax Number 6789714830
14 Provider Enumeration Date 10/19/2011
15 Last Update Date 11/14/2013
16 Authorized Official Last Name DESAI
17 Authorized Official First Name SHAWN
18 Authorized Official Title or Position LAB OPERATIONS MANAGER
19 Authorized Official Telephone Number 6782768411
20 Healthcare Provider Taxonomy Code 1 291U00000X
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Is Organization Subpart N
23 Authorized Official Name Prefix Text DR.

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This page was last updated on: 8/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.