11D2122980 CLIA NUMBER - CENTRE SPRING MD

Laboratory Demographics

CLIA Number: 11D2122980

Facility Name: CENTRE SPRING MD

Facility Address:
10220 MEDLOCK BRIDGE ROAD
JOHNS CREEK, GA
ZIP 30022
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Facility Phone Number: 404 814-9808

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1831553163

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2122980
LAB Type	Physician Office
Facility Name	CENTRE SPRING MD
Street	10220 MEDLOCK BRIDGE ROAD
City	JOHNS CREEK
State	GA
ZIP	30022
Phone	404 814-9808
CertificateType	3
CertificateEffectiveDate	12/12/2022
CertificateExpirationDate	12/11/2024
FacilityType	PPMP

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