11D2308153 CLIA NUMBER - INTEGRATED MEMORY CARE EMORY CLINIC

Laboratory Demographics

  • CLIA Code: 11D2308153
  • Facility Name: INTEGRATED MEMORY CARE EMORY CLINIC
  • Facility Address: 57 EXECUTIVE PARK DRIVE, SUITE 100
    ATLANTA, GA
    ZIP 30329
  • Facility Phone: 404 712-6929
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AMBAR KULSHRESHTHA
  • NPI Number: 1588070940
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 11D2308153
LAB Type Physician Office
Facility Name INTEGRATED MEMORY CARE EMORY CLINIC
Street 57 EXECUTIVE PARK DRIVE, SUITE 100
City ATLANTA
State GA
ZIP 30329
Phone 404 712-6929
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/23/2024
Certificate Expiration Date 7/22/2026
Facility Type Physician Office
Lab Director AMBAR KULSHRESHTHA

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This page was last updated on: 6/4/2025