11D0983964 CLIA NUMBER - EAST COBB FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 11D0983964

Facility Name: EAST COBB FAMILY MEDICINE

Facility Address:
1121 JOHNSON FERRY ROAD, BUILDING 2, SUITE 100
MARIETTA, GA
ZIP 30068
Get Directions

Facility Phone Number: 770 509-0017

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1003366147

Taxonomy: 1223P0221X - Dentist
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

CLIA Record

Field Name	Field Value
CLIA Number	11D0983964
LAB Type	Physician Office
Facility Name	EAST COBB FAMILY MEDICINE
Street	1121 JOHNSON FERRY ROAD, BUILDING 2, SUITE 100
City	MARIETTA
State	GA
ZIP	30068
Phone	770 509-0017
CertificateType	4
CertificateEffectiveDate	7/1/2023
CertificateExpirationDate	6/30/2025
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