11D0855841 CLIA NUMBER - STONE MOUNTAIN FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 11D0855841

Facility Name: STONE MOUNTAIN FAMILY MEDICINE

Facility Address:
1183 A S HAIRSTON ROAD
STONE MOUNTAIN, GA
ZIP 30088
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Facility Phone Number: 404 296-8858

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1194283689

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	11D0855841
LAB Type	Physician Office
Facility Name	STONE MOUNTAIN FAMILY MEDICINE
Street	1183 A S HAIRSTON ROAD
City	STONE MOUNTAIN
State	GA
ZIP	30088
Phone	404 296-8858
CertificateType	4
CertificateEffectiveDate	1/19/2023
CertificateExpirationDate	1/18/2025
FacilityType	Waiver

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