11D0983605 CLIA NUMBER - CONCENTRA - FULTON INDUSTRIAL

Laboratory Demographics

  • CLIA Code: 11D0983605
  • Facility Name: CONCENTRA - FULTON INDUSTRIAL
  • Facility Address: 5670 FULTON INDUSTRIAL, SW
    ATLANTA, GA
    ZIP 30336
  • Facility Phone: 404 344-3930
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHAUN BROWNLEE
  • NPI Number: 1053500751
  • Taxonomy: 261QU0200X - Clinic/Center

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/7/2023
Certificate Expiration Date 10/6/2025
Facility Type Physician Office
Lab Director SHAUN BROWNLEE

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This page was last updated on: 6/4/2025