34D2288030 CLIA NUMBER - ATRIUM HEALTH WAKE FOREST BAPTIST FAMILY MEDICINE NORTHLINE

Laboratory Demographics

  • CLIA Code: 34D2288030
  • Facility Name: ATRIUM HEALTH WAKE FOREST BAPTIST FAMILY MEDICINE NORTHLINE
  • Facility Address: 3120 - 102 NORTHLINE AVENUE
    GREENSBORO, NC
    ZIP 27408
  • Facility Phone: 336 716-7811
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: VICTORIA IVANTCHEV
  • NPI Number: 1477785756
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 34D2288030
LAB Type Physician Office
Facility Name ATRIUM HEALTH WAKE FOREST BAPTIST FAMILY MEDICINE NORTHLINE
Street 3120 - 102 NORTHLINE AVENUE
City GREENSBORO
State NC
ZIP 27408
Phone 336 716-7811
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/21/2025
Certificate Expiration Date 8/20/2027
Facility Type Physician Office
Lab Director VICTORIA IVANTCHEV

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