11D2038401 CLIA NUMBER - CLINICA MEDICA PRENATAL

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Laboratory Demographics

CLIA Number: 11D2038401

Facility Name: CLINICA MEDICA PRENATAL

Facility Address:
4300 BUFORD HIGHWAY, SUITE 216
ATLANTA, GA
ZIP 30346
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Facility Phone Number: 404 636-8282

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1689017170

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2038401
LAB Type	Physician Office
Facility Name	CLINICA MEDICA PRENATAL
Street	4300 BUFORD HIGHWAY, SUITE 216
City	ATLANTA
State	GA
ZIP	30346
Phone	404 636-8282
CertificateType	4
CertificateEffectiveDate	3/20/2024
CertificateExpirationDate	3/19/2026
FacilityType	Waiver

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