11D2083748 CLIA NUMBER - MAGNOLIA HOSPICE, LLC

Laboratory Demographics

  • CLIA Code: 11D2083748
  • Facility Name: MAGNOLIA HOSPICE, LLC
  • Facility Address: 1374 MANCHESTER DRIVE NE
    CONYERS, GA
    ZIP 30012
  • Facility Phone: 770 483-9111
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: GRACE COWARD
  • NPI Number: 1396169074
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 11D2083748
LAB Type Hospice
Facility Name MAGNOLIA HOSPICE, LLC
Street 1374 MANCHESTER DRIVE NE
City CONYERS
State GA
ZIP 30012
Phone 770 483-9111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/11/2024
Certificate Expiration Date 9/10/2026
Facility Type Hospice
Lab Director GRACE COWARD

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