11D1081982 CLIA NUMBER - MEDICAL TRANSPORT NORTHEAST GEORGIA HEALTH SYSTEM

Laboratory Demographics

  • CLIA Code: 11D1081982
  • Facility Name: MEDICAL TRANSPORT NORTHEAST GEORGIA HEALTH SYSTEM
  • Facility Address: 665 LANIER PARK DRIVE, MEDICAL TRANSPORT BLDG
    GAINESVILLE, GA
    ZIP 30501
  • Facility Phone: 770 538-7058
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: MOHAK DAVE
  • NPI Number: 1538103049
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 11D1081982
LAB Type Rural Health Clinic
Facility Name MEDICAL TRANSPORT NORTHEAST GEORGIA HEALTH SYSTEM
Street 665 LANIER PARK DRIVE, MEDICAL TRANSPORT BLDG
City GAINESVILLE
State GA
ZIP 30501
Phone 770 538-7058
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/31/2024
Certificate Expiration Date 3/30/2026
Facility Type Rural Health Clinic
Lab Director MOHAK DAVE

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