11D1000616 CLIA NUMBER - GWINNETT'S PROGRESSIVE HEALTHCARE FOR WOMEN LLC

Laboratory Demographics

CLIA Number: 11D1000616

Facility Name: GWINNETT'S PROGRESSIVE HEALTHCARE FOR WOMEN LLC

Facility Address:
601 A PROFESSIONAL DRIVE, SUITE 260
LAWRENCEVILLE, GA
ZIP 30046
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Facility Phone Number: 770 339-4000

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1952676496

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	11D1000616
LAB Type	Physician Office
Facility Name	GWINNETT'S PROGRESSIVE HEALTHCARE FOR WOMEN LLC
Street	601 A PROFESSIONAL DRIVE, SUITE 260
City	LAWRENCEVILLE
State	GA
ZIP	30046
Phone	770 339-4000
CertificateType	4
CertificateEffectiveDate	6/19/2022
CertificateExpirationDate	6/18/2024
FacilityType	Waiver

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