11D2322530 CLIA NUMBER - MEDPORT LOGISTICS LLC

Laboratory Demographics

  • CLIA Code: 11D2322530
  • Facility Name: MEDPORT LOGISTICS LLC
  • Facility Address: 301 GREEN STREET, NW, SUITE 200R
    GAINESVILLE, GA
    ZIP 30501
  • Facility Phone: 404 620-1500
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: JEREMY LORD
  • NPI Number: 1891684726
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 11D2322530
LAB Type Ambulance
Facility Name MEDPORT LOGISTICS LLC
Street 301 GREEN STREET, NW, SUITE 200R
City GAINESVILLE
State GA
ZIP 30501
Phone 404 620-1500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2025
Certificate Expiration Date 4/22/2027
Facility Type Ambulance
Lab Director JEREMY LORD

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