11D2272915 CLIA NUMBER - VIVASALUD CLINIC 1, LLC

Laboratory Demographics

  • CLIA Code: 11D2272915
  • Facility Name: VIVASALUD CLINIC 1, LLC
  • Facility Address: 2336 WISTERIA DRIVE SUITE 110
    SNELLVILLE, GA
    ZIP 30078
  • Facility Phone: 470 481-7803
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: VANESSA JIMENEZ
  • NPI Number: 1386361756
  • Taxonomy: 207Q00000X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2272915
LAB Type Practitioner Other
Facility Name VIVASALUD CLINIC 1, LLC
Street 2336 WISTERIA DRIVE SUITE 110
City SNELLVILLE
State GA
ZIP 30078
Phone 470 481-7803
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/2/2024
Certificate Expiration Date 12/1/2026
Facility Type Practitioner Other
Lab Director VANESSA JIMENEZ

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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