11D0262298 CLIA NUMBER - ADVENTHEALTH MEDCIAL GROUP FAMILY MEDICINE AT COOK

Laboratory Demographics

CLIA Number: 11D0262298

Facility Name: ADVENTHEALTH MEDCIAL GROUP FAMILY MEDICINE AT COOK

Facility Address:
100 HOSPITAL DRIVE
CHATSWORTH, GA
ZIP 30705
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Facility Phone Number: 706 695-4546

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1669867487

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	11D0262298
LAB Type	Physician Office
Facility Name	ADVENTHEALTH MEDCIAL GROUP FAMILY MEDICINE AT COOK
Street	100 HOSPITAL DRIVE
City	CHATSWORTH
State	GA
ZIP	30705
Phone	706 695-4546
CertificateType	3
CertificateEffectiveDate	8/12/2023
CertificateExpirationDate	8/11/2025
FacilityType	PPMP

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