11D2180410 CLIA NUMBER - NORTHWEST ENT ASSOCIATES PC

Laboratory Demographics

CLIA Number: 11D2180410

Facility Name: NORTHWEST ENT ASSOCIATES PC

Facility Address:
13 REINHARDT COLLEGE PARKWAY
CANTON, GA
ZIP 30114
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Facility Phone Number: 770 427-0368

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1982978466

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2180410
LAB Type	Physician Office
Facility Name	NORTHWEST ENT ASSOCIATES PC
Street	13 REINHARDT COLLEGE PARKWAY
City	CANTON
State	GA
ZIP	30114
Phone	770 427-0368
CertificateType	4
CertificateEffectiveDate	3/13/2024
CertificateExpirationDate	3/12/2026
FacilityType	Waiver

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