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11D2112333 CLIA NUMBER - SOUTH ATLANTA INTERGRATIVE MEDICINE, LLC

Laboratory Demographics

CLIA Number: 11D2112333

Facility Name: SOUTH ATLANTA INTERGRATIVE MEDICINE, LLC

Facility Address:
1240 HWY 54 WEST BUILDIN
FAYETTEVILLE, GA
ZIP 30214
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Facility Phone Number: 770 703-4790

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1760848980

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name Field Value
CLIA Number 11D2112333
LAB Type Physician Office
Facility Name SOUTH ATLANTA INTERGRATIVE MEDICINE, LLC
Street 1240 HWY 54 WEST BUILDIN
City FAYETTEVILLE
State GA
ZIP 30214
Phone 770 703-4790
CertificateType 4
CertificateEffectiveDate 4/27/2024
CertificateExpirationDate 4/26/2026
FacilityType Waiver

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