11D2157184 CLIA NUMBER - DIVINE HOME NURSING

Laboratory Demographics

  • CLIA Code: 11D2157184
  • Facility Name: DIVINE HOME NURSING
  • Facility Address: 2560 MANOR CREEK CT
    CUMMING, GA
    ZIP 30041
  • Facility Phone: 678 696-7177
  • Facility Type: Other - PRIVATE HM CARE PROVIDER
  • Facility Type: Waiver
  • Lab Director: GWENDOLYN M. GOLSON
  • NPI Number: 1144725318
  • Taxonomy: 251E00000X - Home Health

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2157184
LAB Type Other - PRIVATE HM CARE PROVIDER
Facility Name DIVINE HOME NURSING
Street 2560 MANOR CREEK CT
City CUMMING
State GA
ZIP 30041
Phone 678 696-7177
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2024
Certificate Expiration Date 10/31/2026
Facility Type Other - PRIVATE HM CARE PROVIDER
Lab Director GWENDOLYN M. GOLSON

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