11D0941658 CLIA NUMBER - MED FAST PC

Laboratory Demographics

  • CLIA Code: 11D0941658
  • Facility Name: MED FAST PC
  • Facility Address: 902 ATHENS HIGHWAY
    LOGANVILLE, GA
    ZIP 30052
  • Facility Phone: 770 554-5533
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ELIZABETH MIKRUT MD
  • NPI Number: 1487849857
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0941658
LAB Type Physician Office
Facility Name MED FAST PC
Street 902 ATHENS HIGHWAY
City LOGANVILLE
State GA
ZIP 30052
Phone 770 554-5533
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/2/2024
Certificate Expiration Date 3/1/2026
Facility Type Physician Office
Lab Director ELIZABETH MIKRUT MD

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