11D2208970 CLIA NUMBER - SERVICIO MEDICO HISPANO INC

Laboratory Demographics

  • CLIA Code: 11D2208970
  • Facility Name: SERVICIO MEDICO HISPANO INC
  • Facility Address: 3182 SHALLOWFORD ROAD NE
    CHAMBLEE, GA
    ZIP 30341
  • Facility Phone: 770 457-5758
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ADOLFO MOLINA
  • NPI Number: 1851503726
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2208970
LAB Type Physician Office
Facility Name SERVICIO MEDICO HISPANO INC
Street 3182 SHALLOWFORD ROAD NE
City CHAMBLEE
State GA
ZIP 30341
Phone 770 457-5758
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/11/2025
Certificate Expiration Date 1/10/2027
Facility Type Physician Office
Lab Director ADOLFO MOLINA

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