11D2265740 CLIA NUMBER - CENTRO MEDICO SAN ANTONIO

Laboratory Demographics

  • CLIA Code: 11D2265740
  • Facility Name: CENTRO MEDICO SAN ANTONIO
  • Facility Address: 5139 JIMMY CARTER BOULEVARD, SUITE 203
    NORCROSS, GA
    ZIP 30093
  • Facility Phone: 770 885-9684
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEAN PHILIPPE-DAMBERVILLE
  • NPI Number: 1346972858
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2265740
LAB Type Physician Office
Facility Name CENTRO MEDICO SAN ANTONIO
Street 5139 JIMMY CARTER BOULEVARD, SUITE 203
City NORCROSS
State GA
ZIP 30093
Phone 770 885-9684
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/2/2024
Certificate Expiration Date 8/1/2026
Facility Type Physician Office
Lab Director JEAN PHILIPPE-DAMBERVILLE

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