11D2050219 CLIA NUMBER - KL MEDICAL CLINIC, LLC

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Laboratory Demographics

CLIA Number: 11D2050219

Facility Name: KL MEDICAL CLINIC, LLC

Facility Address:
401 WEST PIKE STREET
LAWRENCEVILLE, GA
ZIP 30046
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Facility Phone Number: 678 442-9486

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1356692404

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	11D2050219
LAB Type	Physician Office
Facility Name	KL MEDICAL CLINIC, LLC
Street	401 WEST PIKE STREET
City	LAWRENCEVILLE
State	GA
ZIP	30046
Phone	678 442-9486
CertificateType	4
CertificateEffectiveDate	11/21/2022
CertificateExpirationDate	11/20/2024
FacilityType	Waiver

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