11D2043157 CLIA NUMBER - CENTRO PRENATAL DE GEORGIA

Laboratory Demographics

  • CLIA Code: 11D2043157
  • Facility Name: CENTRO PRENATAL DE GEORGIA
  • Facility Address: 4990 PHILLIPS DRIVE
    FOREST PARK, GA
    ZIP 30297
  • Facility Phone: 404 608-7449
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. TIMOTHY BROWN
  • NPI Number: 1073918207
  • Taxonomy: 364SW0102X - Clinical Nurse Specialist

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CLIA Record

Field Name Field Value
CLIA Number 11D2043157
LAB Type Physician Office
Facility Name CENTRO PRENATAL DE GEORGIA
Street 4990 PHILLIPS DRIVE
City FOREST PARK
State GA
ZIP 30297
Phone 404 608-7449
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/28/2024
Certificate Expiration Date 6/27/2026
Facility Type Physician Office
Lab Director DR. TIMOTHY BROWN

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