11D2261240 CLIA NUMBER - CENTERWELL SENIOR PRIMARY CARE - GROVE PARK

Laboratory Demographics

  • CLIA Code: 11D2261240
  • Facility Name: CENTERWELL SENIOR PRIMARY CARE - GROVE PARK
  • Facility Address: 2056 DONALD LEE HOLLOWELL PARKWAY, NW, SUITE 1
    ATLANTA, GA
    ZIP 30318
  • Facility Phone: 470 890-3910
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ERICA SAVAGE-JETER
  • NPI Number: 1013672815
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2261240
LAB Type Physician Office
Facility Name CENTERWELL SENIOR PRIMARY CARE - GROVE PARK
Street 2056 DONALD LEE HOLLOWELL PARKWAY, NW, SUITE 1
City ATLANTA
State GA
ZIP 30318
Phone 470 890-3910
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/27/2024
Certificate Expiration Date 5/26/2026
Facility Type Physician Office
Lab Director ERICA SAVAGE-JETER

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