11D2180808 CLIA NUMBER - BRC MEDHEALTH, INC

Laboratory Demographics

  • CLIA Code: 11D2180808
  • Facility Name: BRC MEDHEALTH, INC
  • Facility Address: 285 S GLYNN STREET, SUITE 102
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 470 301-4563
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: BARBARA R. CLARK
  • NPI Number: 1689222747
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2180808
LAB Type Practitioner Other
Facility Name BRC MEDHEALTH, INC
Street 285 S GLYNN STREET, SUITE 102
City FAYETTEVILLE
State GA
ZIP 30214
Phone 470 301-4563
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/20/2024
Certificate Expiration Date 3/19/2026
Facility Type Practitioner Other
Lab Director BARBARA R. CLARK

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