11D2067113 CLIA NUMBER - NORTH ATLANTA VASCULAR CLINIC PC

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Laboratory Demographics

CLIA Number: 11D2067113

Facility Name: NORTH ATLANTA VASCULAR CLINIC PC

Facility Address:
2685 PEACHTREE PARKWAY SUITE 320
SUWANEE, GA
ZIP 30024
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Facility Phone Number: 770 771-5260

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1619987682

Taxonomy: 2086S0129X - Surgery
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

CLIA Record

Field Name	Field Value
CLIA Number	11D2067113
LAB Type	Physician Office
Facility Name	NORTH ATLANTA VASCULAR CLINIC PC
Street	2685 PEACHTREE PARKWAY SUITE 320
City	SUWANEE
State	GA
ZIP	30024
Phone	770 771-5260
CertificateType	4
CertificateEffectiveDate	3/12/2024
CertificateExpirationDate	3/11/2026
FacilityType	Waiver

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