11D2231554 CLIA NUMBER - DIVINE GUARDIAN LLC

Laboratory Demographics

  • CLIA Code: 11D2231554
  • Facility Name: DIVINE GUARDIAN LLC
  • Facility Address: 2321 4TH STREET SUITE 120
    TUCKER, GA
    ZIP 30084
  • Facility Phone: 404 513-9330
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: MIRANDA ESKRIDGE
  • NPI Number: 1609494327
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 11D2231554
LAB Type Hospice
Facility Name DIVINE GUARDIAN LLC
Street 2321 4TH STREET SUITE 120
City TUCKER
State GA
ZIP 30084
Phone 404 513-9330
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/4/2025
Certificate Expiration Date 8/3/2027
Facility Type Hospice
Lab Director MIRANDA ESKRIDGE

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