11D2274002 CLIA NUMBER - VILLAGE MEDICAL CUMMING WAG

Laboratory Demographics

  • CLIA Code: 11D2274002
  • Facility Name: VILLAGE MEDICAL CUMMING WAG
  • Facility Address: 2595 PEACHTREE PARKWAY, SUITE 150
    CUMMING, GA
    ZIP 30041
  • Facility Phone: 407 798-8800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NISHANT SHROFF
  • NPI Number: 1780342618
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2274002
LAB Type Physician Office
Facility Name VILLAGE MEDICAL CUMMING WAG
Street 2595 PEACHTREE PARKWAY, SUITE 150
City CUMMING
State GA
ZIP 30041
Phone 407 798-8800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/22/2024
Certificate Expiration Date 12/21/2026
Facility Type Physician Office
Lab Director NISHANT SHROFF

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