11D2237839 CLIA NUMBER - SUGARLOAF PRIMARY CARE

Laboratory Demographics

CLIA Number: 11D2237839

Facility Name: SUGARLOAF PRIMARY CARE

Facility Address:
4835 SUGARLOAF PARKWAY SUITE 300
LAWRENCEVILLE, GA
ZIP 30044
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Facility Phone Number: 470 375-5940

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Waiver

NPI Number: 1699131888

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2237839
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	SUGARLOAF PRIMARY CARE
Street	4835 SUGARLOAF PARKWAY SUITE 300
City	LAWRENCEVILLE
State	GA
ZIP	30044
Phone	470 375-5940
CertificateType	4
CertificateEffectiveDate	9/29/2023
CertificateExpirationDate	9/28/2025
FacilityType	Waiver

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