11D2265467 CLIA NUMBER - MEDTRAK, LLC

Laboratory Demographics

  • CLIA Code: 11D2265467
  • Facility Name: MEDTRAK, LLC
  • Facility Address: 2395 WALL STREET, STE 195
    CONYERS, GA
    ZIP 30013
  • Facility Phone: 678 851-1555
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: THOMAS R. FIELDS
  • NPI Number: 1689286866
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 11D2265467
LAB Type Ambulance
Facility Name MEDTRAK, LLC
Street 2395 WALL STREET, STE 195
City CONYERS
State GA
ZIP 30013
Phone 678 851-1555
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/28/2024
Certificate Expiration Date 7/27/2026
Facility Type Ambulance
Lab Director THOMAS R. FIELDS

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