11D2066290 CLIA NUMBER - PHYSICIAN EXPRESS CARE AT TOWNE LAKE LLC

Laboratory Demographics

  • CLIA Code: 11D2066290
  • Facility Name: PHYSICIAN EXPRESS CARE AT TOWNE LAKE LLC
  • Facility Address: 900 TOWNE LAKE PARKWAY, SUITE 104
    WOODSTOCK, GA
    ZIP 30189
  • Facility Phone: 770 772-1830
  • Facility Type: Other - URGENT CARE CLINIC
  • Facility Type: Waiver
  • Lab Director: RICHARD G. DUKES
  • NPI Number: 1578955795
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2066290
LAB Type Other - URGENT CARE CLINIC
Facility Name PHYSICIAN EXPRESS CARE AT TOWNE LAKE LLC
Street 900 TOWNE LAKE PARKWAY, SUITE 104
City WOODSTOCK
State GA
ZIP 30189
Phone 770 772-1830
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/24/2025
Certificate Expiration Date 9/23/2027
Facility Type Other - URGENT CARE CLINIC
Lab Director RICHARD G. DUKES

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