11D2259236 CLIA NUMBER - SMARTMED LLC

Laboratory Demographics

  • CLIA Code: 11D2259236
  • Facility Name: SMARTMED LLC
  • Facility Address: 612 HOLCOMB BRIDGE ROAD
    ROSWELL, GA
    ZIP 30076
  • Facility Phone: 612 201-2120
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: LUCAS LATHROP
  • NPI Number: 1912643040
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2259236
LAB Type Community Clinic
Facility Name SMARTMED LLC
Street 612 HOLCOMB BRIDGE ROAD
City ROSWELL
State GA
ZIP 30076
Phone 612 201-2120
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/4/2024
Certificate Expiration Date 5/3/2026
Facility Type Community Clinic
Lab Director LUCAS LATHROP

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