21D2269242 CLIA NUMBER - J & G FAMILY PRACTICE LLC

Laboratory Demographics

  • CLIA Code: 21D2269242
  • Facility Name: J & G FAMILY PRACTICE LLC
  • Facility Address: 9331 LIBERTY RD #2D
    RANDALLSTOWN, MD
    ZIP 21133
  • Facility Phone: 301 404-1989
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NGUM AVWONTOM
  • NPI Number: 1700526142
  • Taxonomy: 207QA0505X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D2269242
LAB Type Physician Office
Facility Name J & G FAMILY PRACTICE LLC
Street 9331 LIBERTY RD #2D
City RANDALLSTOWN
State MD
ZIP 21133
Phone 301 404-1989
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/22/2024
Certificate Expiration Date 9/21/2026
Facility Type Physician Office
Lab Director NGUM AVWONTOM

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