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11D2293004 CLIA NUMBER - MOBILE HEALTHCARE PROVIDERS, LLC

Laboratory Demographics

CLIA Number: 11D2293004

Facility Name: MOBILE HEALTHCARE PROVIDERS, LLC

Facility Address:
2256 NORTHLAKE PARKWAY #210
TUCKER, GA
ZIP 30084
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Facility Phone Number: 716 472-5201

Facility Type: Practitioner Other

Certificate Type: Waiver
NPI Number: 1528752383

Taxonomy: 261QC1500X - Clinic/Center

CLIA Record

Field Name Field Value
CLIA Number 11D2293004
LAB Type Practitioner Other
Facility Name MOBILE HEALTHCARE PROVIDERS, LLC
Street 2256 NORTHLAKE PARKWAY #210
City TUCKER
State GA
ZIP 30084
Phone 716 472-5201
CertificateType 4
CertificateEffectiveDate 11/2/2023
CertificateExpirationDate 11/1/2025
FacilityType Waiver

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