11D2065712 CLIA NUMBER - AIR EVAC EMS, INC AIR EVAC #112

Laboratory Demographics

  • CLIA Code: 11D2065712
  • Facility Name: AIR EVAC EMS, INC AIR EVAC #112
  • Facility Address: 827 OLD BREMEN RD
    CARROLLTON, GA
    ZIP 30117
  • Facility Phone: 404 925-6662
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: RUSSELL MCDANIEL
  • NPI Number: 1891030201
  • Taxonomy: 3416A0800X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 11D2065712
LAB Type Ambulance
Facility Name AIR EVAC EMS, INC AIR EVAC #112
Street 827 OLD BREMEN RD
City CARROLLTON
State GA
ZIP 30117
Phone 404 925-6662
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/13/2025
Certificate Expiration Date 9/12/2027
Facility Type Ambulance
Lab Director RUSSELL MCDANIEL

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