Provider Demographics
NPI:1023761756
Name:SHARON ANGELS LAB LLC
Entity type:Organization
Organization Name:SHARON ANGELS LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-342-7437
Mailing Address - Street 1:2200 MCLAURIN ST. STE A
Mailing Address - Street 2:
Mailing Address - City:WAVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39576
Mailing Address - Country:US
Mailing Address - Phone:228-344-3178
Mailing Address - Fax:228-344-3179
Practice Address - Street 1:2200 MCLAURIN ST. STE A
Practice Address - Street 2:
Practice Address - City:WAVELAND
Practice Address - State:MS
Practice Address - Zip Code:39576
Practice Address - Country:US
Practice Address - Phone:228-344-3178
Practice Address - Fax:228-344-3179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251E00000XAgenciesHome Health