11D2285290 CLIA NUMBER - MEDLINK MOBILE 1

Laboratory Demographics

CLIA Number: 11D2285290

Facility Name: MEDLINK MOBILE 1

Facility Address:
11 CHARLIE MORRIS ROAD
COLBERT, GA
ZIP 30628
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Facility Phone Number: 706 788-3234

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1669833364

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2285290
LAB Type	Federally Qualified Health Center
Facility Name	MEDLINK MOBILE 1
Street	11 CHARLIE MORRIS ROAD
City	COLBERT
State	GA
ZIP	30628
Phone	706 788-3234
CertificateType	4
CertificateEffectiveDate	7/11/2023
CertificateExpirationDate	7/10/2025
FacilityType	Waiver

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