11D0885496 CLIA NUMBER - PROFESSIONAL PARK MEDICAL SERVICES PC

Laboratory Demographics

  • CLIA Code: 11D0885496
  • Facility Name: PROFESSIONAL PARK MEDICAL SERVICES PC
  • Facility Address: 100 PROFESSIONAL PARK SUITE 202
    CARROLLTON, GA
    ZIP 30117
  • Facility Phone: (770) 832-6861
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: J TAYLOR GORDON
  • NPI Number: 1386662849
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0885496
LAB Type Physician Office
Facility Name PROFESSIONAL PARK MEDICAL SERVICES PC
Street 100 PROFESSIONAL PARK SUITE 202
City CARROLLTON
State GA
ZIP 30117
Phone 7708326861
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/20/2025
Certificate Expiration Date 3/19/2027
Facility Type Physician Office
Lab Director J TAYLOR GORDON

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