11D0726263 CLIA NUMBER - MCINTOSH TRAIL FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 11D0726263
  • Facility Name: MCINTOSH TRAIL FAMILY PRACTICE
  • Facility Address: 747 SOUTH HILL STREET
    GRIFFIN, GA
    ZIP 30224
  • Facility Phone: (770) 506-1106
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. DAVID A. VAN
  • NPI Number: 1023230422
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0726263
LAB Type Physician Office
Facility Name MCINTOSH TRAIL FAMILY PRACTICE
Street 747 SOUTH HILL STREET
City GRIFFIN
State GA
ZIP 30224
Phone 7705061106
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 3/12/2025
Certificate Expiration Date 3/11/2027
Facility Type Physician Office
Lab Director DR. DAVID A. VAN

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This page was last updated on: 5/18/2026