Provider Demographics
NPI:1174077580
Name:DLS RESEARCH & VENTURES
Entity type:Organization
Organization Name:DLS RESEARCH & VENTURES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/LAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-648-8951
Mailing Address - Street 1:3565 HIGHWAY 20 SE
Mailing Address - Street 2:SUITE R
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2800
Mailing Address - Country:US
Mailing Address - Phone:770-648-8951
Mailing Address - Fax:
Practice Address - Street 1:3565 HIGHWAY 20 SE
Practice Address - Street 2:SUITE R
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2800
Practice Address - Country:US
Practice Address - Phone:770-648-8951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA291U0000X291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory