11D1092514 CLIA NUMBER - SISTERLOVE INCORPORATED

Laboratory Demographics

CLIA Number: 11D1092514

Facility Name: SISTERLOVE INCORPORATED

Facility Address:
1237 RALPH DAVID ABERNATHY BOULEVARD
ATLANTA, GA
ZIP 30310
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Facility Phone Number: 404 505-7777

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1962165712

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	11D1092514
LAB Type	Community Clinic
Facility Name	SISTERLOVE INCORPORATED
Street	1237 RALPH DAVID ABERNATHY BOULEVARD
City	ATLANTA
State	GA
ZIP	30310
Phone	404 505-7777
CertificateType	4
CertificateEffectiveDate	11/26/2022
CertificateExpirationDate	11/25/2024
FacilityType	Waiver

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