11D0721797 CLIA NUMBER - THACKER & THOMPSON MD PC

Laboratory Demographics

  • CLIA Code: 11D0721797
  • Facility Name: THACKER & THOMPSON MD PC
  • Facility Address: 619 RANKIN STREET NE
    ATLANTA, GA
    ZIP 30308
  • Facility Phone: 404 874-3102
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MELANIE A. THOMPSON
  • NPI Number: 1366595118
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0721797
LAB Type Physician Office
Facility Name THACKER & THOMPSON MD PC
Street 619 RANKIN STREET NE
City ATLANTA
State GA
ZIP 30308
Phone 404 874-3102
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/23/2023
Certificate Expiration Date 12/22/2025
Facility Type Physician Office
Lab Director MELANIE A. THOMPSON

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