11D0259510 CLIA NUMBER - KAISER PERMANENTE CRESCENT CENTRE

Laboratory Demographics

  • CLIA Code: 11D0259510
  • Facility Name: KAISER PERMANENTE CRESCENT CENTRE
  • Facility Address: 200 CRESCENT CENTRE PKWY
    TUCKER, GA
    ZIP 30084
  • Facility Phone: 404 295-6381
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CLAUDE J. GANTHIER
  • NPI Number: 1205872686
  • Taxonomy: 3336M0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D0259510
LAB Type Physician Office
Facility Name KAISER PERMANENTE CRESCENT CENTRE
Street 200 CRESCENT CENTRE PKWY
City TUCKER
State GA
ZIP 30084
Phone 404 295-6381
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/11/2025
Certificate Expiration Date 9/10/2027
Facility Type Physician Office
Lab Director CLAUDE J. GANTHIER

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