11D1021772 CLIA NUMBER - ALPHARETTA ROSWELL FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 11D1021772
  • Facility Name: ALPHARETTA ROSWELL FAMILY PRACTICE
  • Facility Address: 2404 MACY DRIVE
    ROSWELL, GA
    ZIP 30076
  • Facility Phone: 770 640-8814
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: FARZANA B. MUMTAZ
  • NPI Number: 1982783304
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1021772
LAB Type Physician Office
Facility Name ALPHARETTA ROSWELL FAMILY PRACTICE
Street 2404 MACY DRIVE
City ROSWELL
State GA
ZIP 30076
Phone 770 640-8814
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/4/2024
Certificate Expiration Date 11/3/2026
Facility Type Physician Office
Lab Director FARZANA B. MUMTAZ

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