11D2014396 CLIA NUMBER - SOUTH ATLANTA URGENT CARE CLINIC, LLC

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Laboratory Demographics

CLIA Number: 11D2014396

Facility Name: SOUTH ATLANTA URGENT CARE CLINIC, LLC

Facility Address:
5185 OLD NATIONAL HIGHWAY
ATLANTA, GA
ZIP 30349
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Facility Phone Number: 404 763-9300

Facility Type: Other - URGENT CARE CLINIC

Certificate Type: Waiver

NPI Number: 1144548363

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2014396
LAB Type	Other - URGENT CARE CLINIC
Facility Name	SOUTH ATLANTA URGENT CARE CLINIC, LLC
Street	5185 OLD NATIONAL HIGHWAY
City	ATLANTA
State	GA
ZIP	30349
Phone	404 763-9300
CertificateType	4
CertificateEffectiveDate	7/18/2023
CertificateExpirationDate	7/17/2025
FacilityType	Waiver

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