11D0872560 CLIA NUMBER - HOWARD S ELLISON MD, PC

Laboratory Demographics

  • CLIA Code: 11D0872560
  • Facility Name: HOWARD S ELLISON MD, PC
  • Facility Address: 1010 EAST FREEWAY DRIVE
    CONYERS, GA
    ZIP 30094
  • Facility Phone: 770 922-8222
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PATTI PETRAZZEWSKY
  • NPI Number: 1962410464
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0872560
LAB Type Physician Office
Facility Name HOWARD S ELLISON MD, PC
Street 1010 EAST FREEWAY DRIVE
City CONYERS
State GA
ZIP 30094
Phone 770 922-8222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/24/2024
Certificate Expiration Date 6/23/2026
Facility Type Physician Office
Lab Director PATTI PETRAZZEWSKY

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