11D2186880 CLIA NUMBER - TEMPLE MED HEALTH

Laboratory Demographics

  • CLIA Code: 11D2186880
  • Facility Name: TEMPLE MED HEALTH
  • Facility Address: 503 MAIN STREET
    VILLA RICA, GA
    ZIP 30180
  • Facility Phone: 770 462-1170
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRANDERLY MALIWA
  • NPI Number: 1346893799
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 11D2186880
LAB Type Physician Office
Facility Name TEMPLE MED HEALTH
Street 503 MAIN STREET
City VILLA RICA
State GA
ZIP 30180
Phone 770 462-1170
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/23/2024
Certificate Expiration Date 6/22/2026
Facility Type Physician Office
Lab Director BRANDERLY MALIWA

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