11D0713174 CLIA NUMBER - FAMILY PRACTICE OF CONYERS

Laboratory Demographics

CLIA Number: 11D0713174

Facility Name: FAMILY PRACTICE OF CONYERS

Facility Address:
1039 EAST FREEWAY DRIVE SE
CONYERS, GA
ZIP 30094
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Facility Phone Number: 770 922-0076

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1720146301

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	11D0713174
LAB Type	Physician Office
Facility Name	FAMILY PRACTICE OF CONYERS
Street	1039 EAST FREEWAY DRIVE SE
City	CONYERS
State	GA
ZIP	30094
Phone	770 922-0076
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