11D2189954 CLIA NUMBER - MOBILE MINI CLINIC

Laboratory Demographics

CLIA Number: 11D2189954

Facility Name: MOBILE MINI CLINIC

Facility Address:
2225 PRICKLY PEAR WALK
LAWRENCEVILLE, GA
ZIP 30043
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Facility Phone Number: 470 207-1866

Facility Type: Other - MOBILE CLINIC

Certificate Type: Waiver

NPI Number: 1194362699

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	11D2189954
LAB Type	Other - MOBILE CLINIC
Facility Name	MOBILE MINI CLINIC
Street	2225 PRICKLY PEAR WALK
City	LAWRENCEVILLE
State	GA
ZIP	30043
Phone	470 207-1866
CertificateType	4
CertificateEffectiveDate	8/7/2022
CertificateExpirationDate	8/6/2024
FacilityType	Waiver

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