11D2017908 CLIA NUMBER - KAISER PERMANENTE FAYETTEVILLE MEDICAL OFFICE

Laboratory Demographics

  • CLIA Code: 11D2017908
  • Facility Name: KAISER PERMANENTE FAYETTEVILLE MEDICAL OFFICE
  • Facility Address: 101 BANKS STATION
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 678 610-3724
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: BELKIS VERA PIMENTEL
  • NPI Number: 1932404274
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 11D2017908
LAB Type Physician Office
Facility Name KAISER PERMANENTE FAYETTEVILLE MEDICAL OFFICE
Street 101 BANKS STATION
City FAYETTEVILLE
State GA
ZIP 30214
Phone 678 610-3724
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 12/21/2024
Certificate Expiration Date 12/20/2026
Facility Type Physician Office
Lab Director BELKIS VERA PIMENTEL

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