11D1039311 CLIA NUMBER - GWINNETT CLINIC

Laboratory Demographics

CLIA Number: 11D1039311

Facility Name: GWINNETT CLINIC

Facility Address:
1289 HWY 124
SNELLVILLE, GA
ZIP 30078
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Facility Phone Number: 770 972-9000

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1134132921

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D1039311
LAB Type	Physician Office
Facility Name	GWINNETT CLINIC
Street	1289 HWY 124
City	SNELLVILLE
State	GA
ZIP	30078
Phone	770 972-9000
CertificateType	4
CertificateEffectiveDate	4/11/2023
CertificateExpirationDate	4/10/2025
FacilityType	Waiver

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