11D2246052 CLIA NUMBER - MEDILAB DIAGNOSTIC, LLC

Laboratory Demographics

  • CLIA Code: 11D2246052
  • Facility Name: MEDILAB DIAGNOSTIC, LLC
  • Facility Address: 6737 BILL CARRUTH PARKWAY, APT 4311
    HIRAM, GA
    ZIP 30141
  • Facility Phone: 770 370-8088
  • Facility Type: Other - DIAGNOSTICS TEST SERV
  • Facility Type: Waiver
  • Lab Director: MARIA GORRATI EJIKE
  • NPI Number: 1972261436
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2246052
LAB Type Other - DIAGNOSTICS TEST SERV
Facility Name MEDILAB DIAGNOSTIC, LLC
Street 6737 BILL CARRUTH PARKWAY, APT 4311
City HIRAM
State GA
ZIP 30141
Phone 770 370-8088
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 Other - DIAGNOSTICS TEST SERV
Lab Director MARIA GORRATI EJIKE

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