11D2310638 CLIA NUMBER - VILLAGE MEDICAL AT HOME

Laboratory Demographics

  • CLIA Code: 11D2310638
  • Facility Name: VILLAGE MEDICAL AT HOME
  • Facility Address: 3445 PEACHTREE ROAD NW, SUITE 1200
    ATLANTA, GA
    ZIP 30326
  • Facility Phone: 470 300-7208
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: IKE NWAOBI
  • NPI Number: 1558872432
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2310638
LAB Type Mobile Laboratory
Facility Name VILLAGE MEDICAL AT HOME
Street 3445 PEACHTREE ROAD NW, SUITE 1200
City ATLANTA
State GA
ZIP 30326
Phone 470 300-7208
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/6/2024
Certificate Expiration Date 9/5/2026
Facility Type Mobile Laboratory
Lab Director IKE NWAOBI

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