11D2067820 CLIA NUMBER - AG FAMILY MEDICINE, PC

Home > CLIA Lookup > 11D2067820

Laboratory Demographics

CLIA Number: 11D2067820

Facility Name: AG FAMILY MEDICINE, PC

Facility Address:
3590 PEACHTREE INDUSTRIAL BLVD
DULUTH, GA
ZIP 30096
Get Directions

Facility Phone Number: 770 614-9799

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1174783435

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2067820
LAB Type	Physician Office
Facility Name	AG FAMILY MEDICINE, PC
Street	3590 PEACHTREE INDUSTRIAL BLVD
City	DULUTH
State	GA
ZIP	30096
Phone	770 614-9799
CertificateType	4
CertificateEffectiveDate	10/23/2023
CertificateExpirationDate	10/22/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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