11D2009265 CLIA NUMBER - GEORGIA WELLNESS GROUP, INC, THE DBA OBRIA MEDICAL CLINICS

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Laboratory Demographics

CLIA Number: 11D2009265

Facility Name: GEORGIA WELLNESS GROUP, INC, THE DBA OBRIA MEDICAL CLINICS

Facility Address:
565 OLD NORCROSS ROAD, SUITE 200
LAWRENCEVILLE, GA
ZIP 30046
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Facility Phone Number: 770 338-1622

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1942834411

Taxonomy: 261QC1500X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2009265
LAB Type	Community Clinic
Facility Name	GEORGIA WELLNESS GROUP, INC, THE DBA OBRIA MEDICAL CLINICS
Street	565 OLD NORCROSS ROAD, SUITE 200
City	LAWRENCEVILLE
State	GA
ZIP	30046
Phone	770 338-1622
CertificateType	4
CertificateEffectiveDate	6/29/2022
CertificateExpirationDate	6/28/2024
FacilityType	Waiver

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