11D2096066 CLIA NUMBER - VILLA RICA ORTHOPAEDICS

Laboratory Demographics

  • CLIA Code: 11D2096066
  • Facility Name: VILLA RICA ORTHOPAEDICS
  • Facility Address: 705 DALLAS HWY, SUITE 301
    VILLA RICA, GA
    ZIP 30180
  • Facility Phone: 000 770-8340
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHN BUTLER
  • NPI Number: 1720215775
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 11D2096066
LAB Type Physician Office
Facility Name VILLA RICA ORTHOPAEDICS
Street 705 DALLAS HWY, SUITE 301
City VILLA RICA
State GA
ZIP 30180
Phone 000 770-8340
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/14/2025
Certificate Expiration Date 5/13/2027
Facility Type Physician Office
Lab Director JOHN BUTLER

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