11D2248155 CLIA NUMBER - REVIVE MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 11D2248155
  • Facility Name: REVIVE MEDICAL CENTER
  • Facility Address: 753 OLD NORCROSS ROAD, SUITE A
    LAWRENCEVILLE, GA
    ZIP 30046
  • Facility Phone: 678 701-6397
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: PAUL JASWAL
  • NPI Number: 1750801205
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2248155
LAB Type Physician Office
Facility Name REVIVE MEDICAL CENTER
Street 753 OLD NORCROSS ROAD, SUITE A
City LAWRENCEVILLE
State GA
ZIP 30046
Phone 678 701-6397
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 5/15/2025
Certificate Expiration Date 5/14/2027
Facility Type Physician Office
Lab Director PAUL JASWAL

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