11D2066290 CLIA NUMBER - PHYSICIAN EXPRESS CARE AT TOWNE LAKE LLC

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Laboratory Demographics

CLIA Number: 11D2066290

Facility Name: PHYSICIAN EXPRESS CARE AT TOWNE LAKE LLC

Facility Address:
900 TOWNE LAKE PARKWAY, SUITE 104
WOODSTOCK, GA
ZIP 30189
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Facility Phone Number: 770 772-1830

Facility Type: Other - URGENT CARE CLINIC

Certificate Type: Waiver

NPI Number: 1578955795

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2066290
LAB Type	Other - URGENT CARE CLINIC
Facility Name	PHYSICIAN EXPRESS CARE AT TOWNE LAKE LLC
Street	900 TOWNE LAKE PARKWAY, SUITE 104
City	WOODSTOCK
State	GA
ZIP	30189
Phone	770 772-1830
CertificateType	4
CertificateEffectiveDate	9/24/2023
CertificateExpirationDate	9/23/2025
FacilityType	Waiver

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