Provider Demographics
NPI:1679580286
Name:CYTOMETRY SPECIALISTS, INC.
Entity type:Organization
Organization Name:CYTOMETRY SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:WICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-477-4402
Mailing Address - Street 1:2580 WESTSIDE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8947
Mailing Address - Country:US
Mailing Address - Phone:800-990-9185
Mailing Address - Fax:678-205-4901
Practice Address - Street 1:2580 WESTSIDE PARKWAY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-8947
Practice Address - Country:US
Practice Address - Phone:800-990-9185
Practice Address - Fax:678-205-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-252291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009932000Medicaid
VA0100102Medicaid
WI36203800Medicaid
LA1148261Medicaid
SCL00118Medicaid
KY612093100OtherUS DEPARTMENT OF LABOR #
NC7001178Medicaid
OH2686286Medicaid
GA000765146AMedicaid
AL009932000Medicaid
GA000765146AMedicaid