11D2244468 CLIA NUMBER - DIVINE LIGHT HOSPICE, LLC

Laboratory Demographics

  • CLIA Code: 11D2244468
  • Facility Name: DIVINE LIGHT HOSPICE, LLC
  • Facility Address: 5750 BROOK HOLLOW PARKWAY SUITE 104
    NORCROSS, GA
    ZIP 30071
  • Facility Phone: 770 696-1703
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: ENID JOHNSON
  • NPI Number: 1326703232
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 11D2244468
LAB Type Hospice
Facility Name DIVINE LIGHT HOSPICE, LLC
Street 5750 BROOK HOLLOW PARKWAY SUITE 104
City NORCROSS
State GA
ZIP 30071
Phone 770 696-1703
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/2/2023
Certificate Expiration Date 12/1/2025
Facility Type Hospice
Lab Director ENID JOHNSON

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