11D2122190 CLIA NUMBER - MINOR MEDICAL HEALTHCARE DBA LIFESTYLE PAIN MGMT & WELLNESS

Laboratory Demographics

CLIA Number: 11D2122190

Facility Name: MINOR MEDICAL HEALTHCARE DBA LIFESTYLE PAIN MGMT & WELLNESS

Facility Address:
1976 MAIN STREET EAST, UNIT C
SNELLVILLE, GA
ZIP 30078
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Facility Phone Number: 912 342-2443

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1780120188

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2122190
LAB Type	Physician Office
Facility Name	MINOR MEDICAL HEALTHCARE DBA LIFESTYLE PAIN MGMT & WELLNESS
Street	1976 MAIN STREET EAST, UNIT C
City	SNELLVILLE
State	GA
ZIP	30078
Phone	912 342-2443
CertificateType	2
CertificateEffectiveDate	8/8/2022
CertificateExpirationDate	8/7/2024
FacilityType	Compliance

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