11D0983605 CLIA NUMBER - CONCENTRA - FULTON INDUSTRIAL

Laboratory Demographics

CLIA Number: 11D0983605

Facility Name: CONCENTRA - FULTON INDUSTRIAL

Facility Address:
5670 FULTON INDUSTRIAL, SW
ATLANTA, GA
ZIP 30336
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Facility Phone Number: 404 344-3930

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1053500751

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D0983605
LAB Type	Physician Office
Facility Name	CONCENTRA - FULTON INDUSTRIAL
Street	5670 FULTON INDUSTRIAL, SW
City	ATLANTA
State	GA
ZIP	30336
Phone	404 344-3930
CertificateType	4
CertificateEffectiveDate	10/7/2023
CertificateExpirationDate	10/6/2025
FacilityType	Waiver

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