01D0894699 CLIA NUMBER - DBA GRANDVIEW MEDICAL GROUP- TRACE CROSSING AFFINITY PHYSICIANS

Laboratory Demographics

CLIA Number: 01D0894699

Facility Name: DBA GRANDVIEW MEDICAL GROUP- TRACE CROSSING AFFINITY PHYSICIANS

Facility Address:
2949 JOHN HAWKINS PARKWY
HOOVER, AL
ZIP 35244
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Facility Phone Number: 205 987-0005

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1508942061

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	01D0894699
LAB Type	Physician Office
Facility Name	DBA GRANDVIEW MEDICAL GROUP- TRACE CROSSING AFFINITY PHYSICIANS
Street	2949 JOHN HAWKINS PARKWY
City	HOOVER
State	AL
ZIP	35244
Phone	205 987-0005
CertificateType	4
CertificateEffectiveDate	7/1/2023
CertificateExpirationDate	6/30/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024