11D2258668 CLIA NUMBER - ADVANCED MEDICAL AND WEIGHT LOSS CENTER

Laboratory Demographics

CLIA Number: 11D2258668

Facility Name: ADVANCED MEDICAL AND WEIGHT LOSS CENTER

Facility Address:
5575 NORTH POINT PARKWAY SUITE 32
ALPHARETTA, GA
ZIP 30022
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Facility Phone Number: 770 467-3975

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1043967268

Taxonomy: 207RA0401X - Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine.

CLIA Record

Field Name	Field Value
CLIA Number	11D2258668
LAB Type	Physician Office
Facility Name	ADVANCED MEDICAL AND WEIGHT LOSS CENTER
Street	5575 NORTH POINT PARKWAY SUITE 32
City	ALPHARETTA
State	GA
ZIP	30022
Phone	770 467-3975
CertificateType	4
CertificateEffectiveDate	4/26/2024
CertificateExpirationDate	4/25/2026
FacilityType	Waiver

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