11D0998471 CLIA NUMBER - ELITE FAMILY PRACTICE PC

Laboratory Demographics

  • CLIA Code: 11D0998471
  • Facility Name: ELITE FAMILY PRACTICE PC
  • Facility Address: 6126 PRESTLEY MILL ROAD, SUITE H
    DOUGLASVILLE, GA
    ZIP 30134
  • Facility Phone: 770 745-6225
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: VALENCIA BURRUSS
  • NPI Number: 1710236880
  • Taxonomy: 305R00000X - Preferred Provider Organization

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CLIA Record

Field Name Field Value
CLIA Number 11D0998471
LAB Type Physician Office
Facility Name ELITE FAMILY PRACTICE PC
Street 6126 PRESTLEY MILL ROAD, SUITE H
City DOUGLASVILLE
State GA
ZIP 30134
Phone 770 745-6225
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 4/16/2024
Certificate Expiration Date 4/15/2026
Facility Type Physician Office
Lab Director VALENCIA BURRUSS

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