10D1081969 CLIA NUMBER - ATLANTIC MEDICAL GROUP LLC

Laboratory Demographics

  • CLIA Code: 10D1081969
  • Facility Name: ATLANTIC MEDICAL GROUP LLC
  • Facility Address: 1541 WICKHAM RD
    WEST MELBOURNE, FL
    ZIP 32904
  • Facility Phone: 321 726-6331
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GEORGE E. ROQUE
  • NPI Number: 1144281247
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D1081969
LAB Type Physician Office
Facility Name ATLANTIC MEDICAL GROUP LLC
Street 1541 WICKHAM RD
City WEST MELBOURNE
State FL
ZIP 32904
Phone 321 726-6331
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/21/2024
Certificate Expiration Date 2/20/2026
Facility Type Physician Office
Lab Director GEORGE E. ROQUE

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This page was last updated on: 9/29/2025