11D2116224 CLIA NUMBER - US MEDCLINIC

Laboratory Demographics

  • CLIA Code: 11D2116224
  • Facility Name: US MEDCLINIC
  • Facility Address: 714 CEDAR STREET
    CARROLLTON, GA
    ZIP 30117
  • Facility Phone: 678 974-1240
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: BRENT A. HARRIS
  • NPI Number: 1417316159
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2116224
LAB Type Physician Office
Facility Name US MEDCLINIC
Street 714 CEDAR STREET
City CARROLLTON
State GA
ZIP 30117
Phone 678 974-1240
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 7/21/2024
Certificate Expiration Date 7/20/2026
Facility Type Physician Office
Lab Director BRENT A. HARRIS

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