11D1064729 CLIA NUMBER - GWINNETT CLINIC LTD

Laboratory Demographics

  • CLIA Code: 11D1064729
  • Facility Name: GWINNETT CLINIC LTD
  • Facility Address: 4870 LAWRNECEVILLE HIGHWAY
    TUCKER, GA
    ZIP 30084
  • Facility Phone: 770 496-1429
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MEENA J. SHAH
  • NPI Number: 1013085513
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1064729
LAB Type Physician Office
Facility Name GWINNETT CLINIC LTD
Street 4870 LAWRNECEVILLE HIGHWAY
City TUCKER
State GA
ZIP 30084
Phone 770 496-1429
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/13/2025
Certificate Expiration Date 2/12/2027
Facility Type Physician Office
Lab Director MEENA J. SHAH

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