11D2003621 CLIA NUMBER - LIFETIME MEDICAL CENTER, PC

Laboratory Demographics

  • CLIA Code: 11D2003621
  • Facility Name: LIFETIME MEDICAL CENTER, PC
  • Facility Address: 14244 HWY 515 N- SUITE 100
    ELLIJAY, GA
    ZIP 30536
  • Facility Phone: 706 698-5433
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LEE KENT
  • NPI Number: 1982933107
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2003621
LAB Type Physician Office
Facility Name LIFETIME MEDICAL CENTER, PC
Street 14244 HWY 515 N- SUITE 100
City ELLIJAY
State GA
ZIP 30536
Phone 706 698-5433
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/15/2024
Certificate Expiration Date 2/14/2026
Facility Type Physician Office
Lab Director LEE KENT

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