11D1016701 CLIA NUMBER - GRACE MEDICAL CLINIC PC

Laboratory Demographics

  • CLIA Code: 11D1016701
  • Facility Name: GRACE MEDICAL CLINIC PC
  • Facility Address: 230 B WEST COLLEGE STREET
    GRIFFIN, GA
    ZIP 30224
  • Facility Phone: 678 688-1155
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EHI PHILIP OSEHOBO MD
  • NPI Number: 1093887168
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1016701
LAB Type Physician Office
Facility Name GRACE MEDICAL CLINIC PC
Street 230 B WEST COLLEGE STREET
City GRIFFIN
State GA
ZIP 30224
Phone 678 688-1155
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/5/2025
Certificate Expiration Date 9/4/2027
Facility Type Physician Office
Lab Director EHI PHILIP OSEHOBO MD

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This page was last updated on: 9/29/2025