11D2135672 CLIA NUMBER - PRODIAGNOSTICS MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 11D2135672
  • Facility Name: PRODIAGNOSTICS MEDICAL CENTER
  • Facility Address: 6460 HIGHWAY 92, SUITE 200
    ACWORTH, GA
    ZIP 30102
  • Facility Phone: 678 915-1891
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CARLOS A. ESCOBAR
  • NPI Number: 1720598030
  • Taxonomy: 363LF0000X - Nurse Practitioner

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2135672
LAB Type Physician Office
Facility Name PRODIAGNOSTICS MEDICAL CENTER
Street 6460 HIGHWAY 92, SUITE 200
City ACWORTH
State GA
ZIP 30102
Phone 678 915-1891
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/25/2025
Certificate Expiration Date 8/24/2027
Facility Type Physician Office
Lab Director CARLOS A. ESCOBAR

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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