11D2253544 CLIA NUMBER - JENCARE SENIOR MEDICAL CENTER - HAMMOND PARK

Laboratory Demographics

CLIA Number: 11D2253544

Facility Name: JENCARE SENIOR MEDICAL CENTER - HAMMOND PARK

Facility Address:
2720 METROPOLITAN PARKWAY, SW
ATLANTA, GA
ZIP 30315
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Facility Phone Number: 305 842-3910

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1013661438

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	11D2253544
LAB Type	Physician Office
Facility Name	JENCARE SENIOR MEDICAL CENTER - HAMMOND PARK
Street	2720 METROPOLITAN PARKWAY, SW
City	ATLANTA
State	GA
ZIP	30315
Phone	305 842-3910
CertificateType	4
CertificateEffectiveDate	2/22/2024
CertificateExpirationDate	2/21/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024