11D2245972 CLIA NUMBER - PROACTIVE MD MISSION TO THE WORLD

Laboratory Demographics

  • CLIA Code: 11D2245972
  • Facility Name: PROACTIVE MD MISSION TO THE WORLD
  • Facility Address: 1600 N BROWN ROAD
    LAWRENCEVILLE, GA
    ZIP 30043
  • Facility Phone: 678 527-7900
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: EDA KIM
  • NPI Number: 1780340117
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2245972
LAB Type Practitioner Other
Facility Name PROACTIVE MD MISSION TO THE WORLD
Street 1600 N BROWN ROAD
City LAWRENCEVILLE
State GA
ZIP 30043
Phone 678 527-7900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/20/2023
Certificate Expiration Date 12/19/2025
Facility Type Practitioner Other
Lab Director EDA KIM

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