11D2057802 CLIA NUMBER - JENCARE NEIGHBORHOOD MEDICAL CTR WEST END, LLC

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Laboratory Demographics

CLIA Number: 11D2057802

Facility Name: JENCARE NEIGHBORHOOD MEDICAL CTR WEST END, LLC

Facility Address:
1325 RALPH DAVID ABERNATHY BLVD, SW
ATLANTA, GA
ZIP 30310
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Facility Phone Number: 305 628-6117

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1811230014

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	11D2057802
LAB Type	Physician Office
Facility Name	JENCARE NEIGHBORHOOD MEDICAL CTR WEST END, LLC
Street	1325 RALPH DAVID ABERNATHY BLVD, SW
City	ATLANTA
State	GA
ZIP	30310
Phone	305 628-6117
CertificateType	4
CertificateEffectiveDate	4/24/2023
CertificateExpirationDate	4/23/2025
FacilityType	Waiver

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