11D2156572 CLIA NUMBER - PEACHTREE OCCUPATIONAL MEDICINE AND URGENT CARE

Laboratory Demographics

CLIA Number: 11D2156572

Facility Name: PEACHTREE OCCUPATIONAL MEDICINE AND URGENT CARE

Facility Address:
3300 HOLCOMB BRIDGE ROAD, SUITE 110
NORCROSS, GA
ZIP 30092
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Facility Phone Number: 770 449-5161

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1679048003

Taxonomy: 261QX0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2156572
LAB Type	Physician Office
Facility Name	PEACHTREE OCCUPATIONAL MEDICINE AND URGENT CARE
Street	3300 HOLCOMB BRIDGE ROAD, SUITE 110
City	NORCROSS
State	GA
ZIP	30092
Phone	770 449-5161
CertificateType	4
CertificateEffectiveDate	10/22/2022
CertificateExpirationDate	10/21/2024
FacilityType	Waiver

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