11D2278434 CLIA NUMBER - HILLANDALE PRIMARY CARE

Laboratory Demographics

CLIA Number: 11D2278434

Facility Name: HILLANDALE PRIMARY CARE

Facility Address:
2523 PANOLA ROAD
LITHONIA, GA
ZIP 30058
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Facility Phone Number: 770 322-9660

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1811422322

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2278434
LAB Type	Physician Office
Facility Name	HILLANDALE PRIMARY CARE
Street	2523 PANOLA ROAD
City	LITHONIA
State	GA
ZIP	30058
Phone	770 322-9660
CertificateType	4
CertificateEffectiveDate	3/17/2023
CertificateExpirationDate	3/16/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024