11D0259285 CLIA NUMBER - GRANT PARK FAMILY HEALTH CENTER INC

Laboratory Demographics

  • CLIA Code: 11D0259285
  • Facility Name: GRANT PARK FAMILY HEALTH CENTER INC
  • Facility Address: 1340 BOULEVARD SOUTH EAST
    ATLANTA, GA
    ZIP 30315
  • Facility Phone: 404 627-4259
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: TERRY WOOD MD
  • NPI Number: 1871669358
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0259285
LAB Type Community Clinic
Facility Name GRANT PARK FAMILY HEALTH CENTER INC
Street 1340 BOULEVARD SOUTH EAST
City ATLANTA
State GA
ZIP 30315
Phone 404 627-4259
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 3/10/2024
Certificate Expiration Date 3/9/2026
Facility Type Community Clinic
Lab Director TERRY WOOD MD

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This page was last updated on: 6/4/2025