11D2308380 CLIA NUMBER - OPTUMMD, LLC

Laboratory Demographics

  • CLIA Code: 11D2308380
  • Facility Name: OPTUMMD, LLC
  • Facility Address: 91 W WIEUCA ROAD, NE, BLDG A 1000
    ATLANTA, GA
    ZIP 30342
  • Facility Phone: 404 257-5585
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWARD A. ESPINOSA
  • NPI Number: 1629816459
  • Taxonomy: 207R00000X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2308380
LAB Type Physician Office
Facility Name OPTUMMD, LLC
Street 91 W WIEUCA ROAD, NE, BLDG A 1000
City ATLANTA
State GA
ZIP 30342
Phone 404 257-5585
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/26/2024
Certificate Expiration Date 7/25/2026
Facility Type Physician Office
Lab Director EDWARD A. ESPINOSA

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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