11D2110908 CLIA NUMBER - FAYETTE CARE CLINIC, INC

Laboratory Demographics

  • CLIA Code: 11D2110908
  • Facility Name: FAYETTE CARE CLINIC, INC
  • Facility Address: 105C BRADFORD SQUARE
    FAYETTEVILLE, GA
    ZIP 30215
  • Facility Phone: 770 719-4620
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: GENEVA WEAVER
  • NPI Number: 1003552282
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2110908
LAB Type Community Clinic
Facility Name FAYETTE CARE CLINIC, INC
Street 105C BRADFORD SQUARE
City FAYETTEVILLE
State GA
ZIP 30215
Phone 770 719-4620
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/28/2024
Certificate Expiration Date 3/27/2026
Facility Type Community Clinic
Lab Director GENEVA WEAVER

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