11D1028926 CLIA NUMBER - FAMILY PRACTICE AT PEACHTREE DUNWOODY

Laboratory Demographics

  • CLIA Code: 11D1028926
  • Facility Name: FAMILY PRACTICE AT PEACHTREE DUNWOODY
  • Facility Address: 1140 HAMMOND DRIVE SUITE G 7150
    ATLANTA, GA
    ZIP 30328
  • Facility Phone: 770 481-0019
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: KEVIN B. HICKS
  • NPI Number: 1538347398
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1028926
LAB Type Physician Office
Facility Name FAMILY PRACTICE AT PEACHTREE DUNWOODY
Street 1140 HAMMOND DRIVE SUITE G 7150
City ATLANTA
State GA
ZIP 30328
Phone 770 481-0019
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 8/5/2024
Certificate Expiration Date 8/4/2026
Facility Type Physician Office
Lab Director KEVIN B. HICKS

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