11D2108660 CLIA NUMBER - DULUTH FAMILY PRACTICE, LLC

Laboratory Demographics

  • CLIA Code: 11D2108660
  • Facility Name: DULUTH FAMILY PRACTICE, LLC
  • Facility Address: 4470 SATELITE BLVD, SUITE #204
    DULUTH, GA
    ZIP 30096
  • Facility Phone: 770 858-5983
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: LIEM C. NGO
  • NPI Number: 1730558735
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2108660
LAB Type Physician Office
Facility Name DULUTH FAMILY PRACTICE, LLC
Street 4470 SATELITE BLVD, SUITE #204
City DULUTH
State GA
ZIP 30096
Phone 770 858-5983
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 2/9/2024
Certificate Expiration Date 2/8/2026
Facility Type Physician Office
Lab Director LIEM C. NGO

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This page was last updated on: 3/20/2025