11D2003401 CLIA NUMBER - GRACE MEDICAL PRACTICE, LTD

Laboratory Demographics

  • CLIA Code: 11D2003401
  • Facility Name: GRACE MEDICAL PRACTICE, LTD
  • Facility Address: 3885 PRINCETON LAKES WAY
    ATLANTA, GA
    ZIP 30331
  • Facility Phone: 404 763-1240
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. FIDELIA OSINUBI
  • NPI Number: 1396070744
  • Taxonomy: 207Q00000X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2003401
LAB Type Physician Office
Facility Name GRACE MEDICAL PRACTICE, LTD
Street 3885 PRINCETON LAKES WAY
City ATLANTA
State GA
ZIP 30331
Phone 404 763-1240
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/9/2024
Certificate Expiration Date 2/8/2026
Facility Type Physician Office
Lab Director DR. FIDELIA OSINUBI

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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