11D2288143 CLIA NUMBER - PIEDMONT VIP

Laboratory Demographics

CLIA Number: 11D2288143

Facility Name: PIEDMONT VIP

Facility Address:
105 COLLIER ROAD, SUITE 5000
ATLANTA, GA
ZIP 30309
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Facility Phone Number: 404 609-5566

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1922047893

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	11D2288143
LAB Type	Physician Office
Facility Name	PIEDMONT VIP
Street	105 COLLIER ROAD, SUITE 5000
City	ATLANTA
State	GA
ZIP	30309
Phone	404 609-5566
CertificateType	4
CertificateEffectiveDate	8/22/2023
CertificateExpirationDate	8/21/2025
FacilityType	Waiver

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