| LCA CASE NUMBER | I-200-21215-499624 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2021-08-03 |
| DECISION DATE | 2021-08-10 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Medical Technologist |
| SOC CODE | 29-2011.00 |
| SOC TITLE | Medical and Clinical Laboratory Technologists |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2022-01-06 |
| END DATE | 2025-01-05 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 1 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | Coffee Regional Medical Center, Inc. |
| EMPLOYER ADDRESS1 | 1101 Ocilla Road |
| EMPLOYER CITY | Douglas |
| EMPLOYER STATE | GA |
| EMPLOYER POSTAL CODE | 31533 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 19123841900 |
| EMPLOYER PHONE EXT | 4511 |
| NAICS CODE | 6221 |
| EMPLOYER POC LAST NAME | Lewis |
| EMPLOYER POC FIRST NAME | Vicki |
| EMPLOYER POC JOB TITLE | President & Chief Executive Officer |
| EMPLOYER POC ADDRESS1 | 1101 Ocilla Road |
| EMPLOYER POC CITY | Douglas |
| EMPLOYER POC STATE | GA |
| EMPLOYER POC POSTAL CODE | 31533 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 19123841900 |
| EMPLOYER POC PHONE EXT | 4511 |
| EMPLOYER POC EMAIL | Vicki.Lewis@coffeeregional.org |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Jahan |
| AGENT ATTORNEY FIRST NAME | Ashik |
| AGENT ATTORNEY MIDDLE NAME | Rahman |
| AGENT ATTORNEY ADDRESS1 | 191 Peachtree Street, NE |
| AGENT ATTORNEY ADDRESS2 | Suite 2900 |
| AGENT ATTORNEY CITY | Atlanta |
| AGENT ATTORNEY STATE | GA |
| AGENT ATTORNEY POSTAL CODE | 30303 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 14049546971 |
| AGENT ATTORNEY EMAIL ADDRESS | AJahan@hallboothsmith.com |
|
| LAWFIRM NAME BUSINESS NAME | Hall Booth Smith, P.C. |
| STATE OF HIGHEST COURT | GA |
| NAME OF HIGHEST STATE COURT | Supreme Court of Georgia |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 1101 Ocilla Road |
| LCA CASE WORKLOC1 CITY | Douglas |
| WORKSITE COUNTY | COFFEE |
| LCA CASE WORKLOC1 STATE | GA |
| WORKSITE POSTAL CODE | 31533 |
| LCA CASE WAGE RATE FROM | 63722 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 58573 |
| PW UNIT OF PAY | Year |
| PW WAGE LEVEL | IV |
| PW OES YEAR | 7/1/2021 - 6/30/2022 |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | True |
| H-1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business |
