11D2103757 CLIA NUMBER - COBB MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 11D2103757
  • Facility Name: COBB MEDICAL CLINIC
  • Facility Address: 2615 EAST WEST CONNECTOR, SUITE 106
    AUSTELL, GA
    ZIP 30106
  • Facility Phone: 770 941-0010
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHAH B. CHANDRESH
  • NPI Number: 1922553023
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2103757
LAB Type Physician Office
Facility Name COBB MEDICAL CLINIC
Street 2615 EAST WEST CONNECTOR, SUITE 106
City AUSTELL
State GA
ZIP 30106
Phone 770 941-0010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/20/2023
Certificate Expiration Date 10/19/2025
Facility Type Physician Office
Lab Director SHAH B. CHANDRESH

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This page was last updated on: 6/4/2025