11D2252566 CLIA NUMBER - AMBROSIA FUNCTIONAL MEDICINE

Laboratory Demographics

  • CLIA Code: 11D2252566
  • Facility Name: AMBROSIA FUNCTIONAL MEDICINE
  • Facility Address: 480 EAST PACES FERRY ROAD, SUITE 8
    ATLANTA, GA
    ZIP 30305
  • Facility Phone: 404 858-4564
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOANN DONALDSON
  • NPI Number: 1073270997
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2252566
LAB Type Physician Office
Facility Name AMBROSIA FUNCTIONAL MEDICINE
Street 480 EAST PACES FERRY ROAD, SUITE 8
City ATLANTA
State GA
ZIP 30305
Phone 404 858-4564
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/13/2024
Certificate Expiration Date 2/12/2026
Facility Type Physician Office
Lab Director JOANN DONALDSON

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