11D2081383 CLIA NUMBER - GREEN PARK PCH

Laboratory Demographics

  • CLIA Code: 11D2081383
  • Facility Name: GREEN PARK PCH
  • Facility Address: 2941 SANDY PLACE RD
    MARIETTA, GA
    ZIP 30066
  • Facility Phone: 770 971-5394
  • Facility Type: Other - PERSONAL CARE HOME
  • Facility Type: Waiver
  • Lab Director: ROBERT L. EMEFIELEO
  • NPI Number: 1437439676
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D2081383
LAB Type Other - PERSONAL CARE HOME
Facility Name GREEN PARK PCH
Street 2941 SANDY PLACE RD
City MARIETTA
State GA
ZIP 30066
Phone 770 971-5394
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/24/2024
Certificate Expiration Date 7/23/2026
Facility Type Other - PERSONAL CARE HOME
Lab Director ROBERT L. EMEFIELEO

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This page was last updated on: 9/29/2025