11D1061089 CLIA NUMBER - CENTRO PRENATAL DE GWINNETT

Laboratory Demographics

CLIA Number: 11D1061089

Facility Name: CENTRO PRENATAL DE GWINNETT

Facility Address:
575 1 W PIKE STREET
LAWRENCEVILLE, GA
ZIP 30046
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Facility Phone Number: 770 277-0230

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1578113585

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name	Field Value
CLIA Number	11D1061089
LAB Type	Physician Office
Facility Name	CENTRO PRENATAL DE GWINNETT
Street	575 1 W PIKE STREET
City	LAWRENCEVILLE
State	GA
ZIP	30046
Phone	770 277-0230
CertificateType	3
CertificateEffectiveDate	11/9/2022
CertificateExpirationDate	11/8/2024
FacilityType	PPMP

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