11D2081634 CLIA NUMBER - ALPHA FAMILY MEDICINE INC

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Laboratory Demographics

CLIA Number: 11D2081634

Facility Name: ALPHA FAMILY MEDICINE INC

Facility Address:
480 NORTH MAIN STREET, SUITE 202
ALPHARETTA, GA
ZIP 30009
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Facility Phone Number: 678 619-1974

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1205243458

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2081634
LAB Type	Physician Office
Facility Name	ALPHA FAMILY MEDICINE INC
Street	480 NORTH MAIN STREET, SUITE 202
City	ALPHARETTA
State	GA
ZIP	30009
Phone	678 619-1974
CertificateType	4
CertificateEffectiveDate	7/29/2022
CertificateExpirationDate	7/28/2024
FacilityType	Waiver

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