11D2284054 CLIA NUMBER - ALIVE HEALTH AND WELLNESS LLC

Laboratory Demographics

CLIA Number: 11D2284054

Facility Name: ALIVE HEALTH AND WELLNESS LLC

Facility Address:
377 WEST PIKE STREET SUITE A-3
LAWRENCEVILLE, GA
ZIP 30046
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Facility Phone Number: 470 635-2225

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1053011452

Taxonomy: 363LP2300X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	11D2284054
LAB Type	Physician Office
Facility Name	ALIVE HEALTH AND WELLNESS LLC
Street	377 WEST PIKE STREET SUITE A-3
City	LAWRENCEVILLE
State	GA
ZIP	30046
Phone	470 635-2225
CertificateType	4
CertificateEffectiveDate	6/16/2023
CertificateExpirationDate	6/15/2025
FacilityType	Waiver

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