11D1088184 CLIA NUMBER - AIR EVAC 77

Laboratory Demographics

  • CLIA Code: 11D1088184
  • Facility Name: AIR EVAC 77
  • Facility Address: 455 AEROTRON PKWY
    LAGRANGE, GA
    ZIP 30240
  • Facility Phone: 706 845-7805
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: RICHARD BIAS
  • NPI Number: 1285802751
  • Taxonomy: 3416A0800X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 11D1088184
LAB Type Ambulance
Facility Name AIR EVAC 77
Street 455 AEROTRON PKWY
City LAGRANGE
State GA
ZIP 30240
Phone 706 845-7805
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/19/2024
Certificate Expiration Date 8/18/2026
Facility Type Ambulance
Lab Director RICHARD BIAS

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