11D2201670 CLIA NUMBER - PROACTIVE MD-TINDALL CONLEY HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 11D2201670
  • Facility Name: PROACTIVE MD-TINDALL CONLEY HEALTH CENTER
  • Facility Address: 3361 GRANT ROAD
    CONLEY, GA
    ZIP 30288
  • Facility Phone: 678 244-7933
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MICHELLE ADEGBEMLE
  • NPI Number: 1265035877
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2201670
LAB Type Practitioner Other
Facility Name PROACTIVE MD-TINDALL CONLEY HEALTH CENTER
Street 3361 GRANT ROAD
City CONLEY
State GA
ZIP 30288
Phone 678 244-7933
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/23/2024
Certificate Expiration Date 11/22/2026
Facility Type Practitioner Other
Lab Director MICHELLE ADEGBEMLE

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