11D2119917 CLIA NUMBER - FP - PEACHTREE IMMEDIATE CARE - GWI

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Laboratory Demographics

CLIA Number: 11D2119917

Facility Name: FP - PEACHTREE IMMEDIATE CARE - GWI

Facility Address:
3551 SATELLITE BLVD
DULUTH, GA
ZIP 30096
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Facility Phone Number: 770 476-3000

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1770754772

Taxonomy: 1223P0221X - Dentist
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

CLIA Record

Field Name	Field Value
CLIA Number	11D2119917
LAB Type	Physician Office
Facility Name	FP - PEACHTREE IMMEDIATE CARE - GWI
Street	3551 SATELLITE BLVD
City	DULUTH
State	GA
ZIP	30096
Phone	770 476-3000
CertificateType	4
CertificateEffectiveDate	10/6/2022
CertificateExpirationDate	10/5/2024
FacilityType	Waiver

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