11D1075286 CLIA NUMBER - GWINNETT CLINIC LTD

Laboratory Demographics

CLIA Number: 11D1075286

Facility Name: GWINNETT CLINIC LTD

Facility Address:
1740 LAWRENCEVILLE HIGHWAY
LAWRENCEVILLE, GA
ZIP 30044
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Facility Phone Number: 770 995-5695

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1215005715

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D1075286
LAB Type	Physician Office
Facility Name	GWINNETT CLINIC LTD
Street	1740 LAWRENCEVILLE HIGHWAY
City	LAWRENCEVILLE
State	GA
ZIP	30044
Phone	770 995-5695
CertificateType	4
CertificateEffectiveDate	10/17/2023
CertificateExpirationDate	10/16/2025
FacilityType	Waiver

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