11D1031245 CLIA NUMBER - FAMILY CARE CLINIC, THE

Laboratory Demographics

CLIA Number: 11D1031245

Facility Name: FAMILY CARE CLINIC, THE

Facility Address:
3985 STEVE REYNOLDS BOULEVARD BUILDING 1
NORCROSS, GA
ZIP 30093
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Facility Phone Number: 770 622-3948

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1245406438

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	11D1031245
LAB Type	Practitioner Other
Facility Name	FAMILY CARE CLINIC, THE
Street	3985 STEVE REYNOLDS BOULEVARD BUILDING 1
City	NORCROSS
State	GA
ZIP	30093
Phone	770 622-3948
CertificateType	4
CertificateEffectiveDate	9/27/2022
CertificateExpirationDate	9/26/2024
FacilityType	Waiver

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