11D1059979 CLIA NUMBER - CLAIRMONT MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 11D1059979

Facility Name: CLAIRMONT MEDICAL CLINIC

Facility Address:
3490 CLAIRMONT ROAD
ATLANTA, GA
ZIP 30319
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Facility Phone Number: 404 477-1218

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1659552115

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D1059979
LAB Type	Physician Office
Facility Name	CLAIRMONT MEDICAL CLINIC
Street	3490 CLAIRMONT ROAD
City	ATLANTA
State	GA
ZIP	30319
Phone	404 477-1218
CertificateType	4
CertificateEffectiveDate	10/12/2022
CertificateExpirationDate	10/11/2024
FacilityType	Waiver

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