11D2290537 CLIA NUMBER - MOULTRIE MEDICAL PC

Laboratory Demographics

  • CLIA Code: 11D2290537
  • Facility Name: MOULTRIE MEDICAL PC
  • Facility Address: 2970 CLAIRMONT ROAD, NE, SUITE 210
    BROOKHAVEN, GA
    ZIP 30329
  • Facility Phone: 404 236-9502
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHN C. MOULTRIE
  • NPI Number: 1215618640
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2290537
LAB Type Physician Office
Facility Name MOULTRIE MEDICAL PC
Street 2970 CLAIRMONT ROAD, NE, SUITE 210
City BROOKHAVEN
State GA
ZIP 30329
Phone 404 236-9502
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/27/2025
Certificate Expiration Date 9/26/2027
Facility Type Physician Office
Lab Director JOHN C. MOULTRIE

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