11D0672722 CLIA NUMBER - PREMISE HEALTH OF GEORGIA MEDICAL, PC

Laboratory Demographics

  • CLIA Code: 11D0672722
  • Facility Name: PREMISE HEALTH OF GEORGIA MEDICAL, PC
  • Facility Address: 86 SOUTH COBB DRIVE, BLDG-1, T660, MAIL DROP 0454
    MARIETTA, GA
    ZIP 30063
  • Facility Phone: 770 494-4131
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TURQUOISE HOLMES
  • NPI Number: 1154584548
  • Taxonomy: 261QX0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0672722
LAB Type Physician Office
Facility Name PREMISE HEALTH OF GEORGIA MEDICAL, PC
Street 86 SOUTH COBB DRIVE, BLDG-1, T660, MAIL DROP 0454
City MARIETTA
State GA
ZIP 30063
Phone 770 494-4131
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/8/2025
Certificate Expiration Date 8/7/2027
Facility Type Physician Office
Lab Director TURQUOISE HOLMES

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