11D2291512 CLIA NUMBER - FRONTLINE AMBULANCE SERVICE, LLC

Laboratory Demographics

  • CLIA Code: 11D2291512
  • Facility Name: FRONTLINE AMBULANCE SERVICE, LLC
  • Facility Address: 5825 GLENRIDGE DRIVE, BLDG 3, SUITE 245
    ATLANTA, GA
    ZIP 30328
  • Facility Phone: 404 666-2115
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: MARLON BEVAUN
  • NPI Number: 1417725219
  • Taxonomy: 341600000X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 11D2291512
LAB Type Ambulance
Facility Name FRONTLINE AMBULANCE SERVICE, LLC
Street 5825 GLENRIDGE DRIVE, BLDG 3, SUITE 245
City ATLANTA
State GA
ZIP 30328
Phone 404 666-2115
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/11/2023
Certificate Expiration Date 10/10/2025
Facility Type Ambulance
Lab Director MARLON BEVAUN

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