11D0876169 CLIA NUMBER - PREMISE HEALTH OF GEORGIA MEDICAL, PC

Laboratory Demographics

CLIA Number: 11D0876169

Facility Name: PREMISE HEALTH OF GEORGIA MEDICAL, PC

Facility Address:
1128 SOUTH PARK STREET
CARROLLTON, GA
ZIP 30119
Get Directions

Facility Phone Number: 770 836-0870

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1437213709

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	11D0876169
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF GEORGIA MEDICAL, PC
Street	1128 SOUTH PARK STREET
City	CARROLLTON
State	GA
ZIP	30119
Phone	770 836-0870
CertificateType	4
CertificateEffectiveDate	7/17/2022
CertificateExpirationDate	7/16/2024
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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