11D1077247 CLIA NUMBER - GWINNETT CLINIC LTD

Laboratory Demographics

  • CLIA Code: 11D1077247
  • Facility Name: GWINNETT CLINIC LTD
  • Facility Address: 10600 MEDLOCK BRIDGE
    DULUTH, GA
    ZIP 30097
  • Facility Phone: 770 418-0818
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: M J. SHAH MD
  • NPI Number: 1164590576
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1077247
LAB Type Physician Office
Facility Name GWINNETT CLINIC LTD
Street 10600 MEDLOCK BRIDGE
City DULUTH
State GA
ZIP 30097
Phone 770 418-0818
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/5/2023
Certificate Expiration Date 12/4/2025
Facility Type Physician Office
Lab Director M J. SHAH MD

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