11D2103316 CLIA NUMBER - MOREHOUSE SCHOOL OF MEDICINE STUDENT HEALTH AND WELLNESS CENTER

Laboratory Demographics

CLIA Number: 11D2103316

Facility Name: MOREHOUSE SCHOOL OF MEDICINE STUDENT HEALTH AND WELLNESS CENTER

Facility Address:
455 LEE STREET, 3RD FLOOR
ATLANTA, GA
ZIP 30310
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Facility Phone Number: 404 756-1353

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1285137927

Taxonomy: 390200000X - Student in an Organized Health Care Education/Training Program
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

CLIA Record

Field Name	Field Value
CLIA Number	11D2103316
LAB Type	Physician Office
Facility Name	MOREHOUSE SCHOOL OF MEDICINE STUDENT HEALTH AND WELLNESS CENTER
Street	455 LEE STREET, 3RD FLOOR
City	ATLANTA
State	GA
ZIP	30310
Phone	404 756-1353
CertificateType	3
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	PPMP

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