11D2116568 CLIA NUMBER - FIELDALE FARMS FAMILY HEALTH CARE CTR & PHARMACY

Laboratory Demographics

  • CLIA Code: 11D2116568
  • Facility Name: FIELDALE FARMS FAMILY HEALTH CARE CTR & PHARMACY
  • Facility Address: 184B PROFESSIONAL DR
    BALDWIN, GA
    ZIP 30511
  • Facility Phone: 866 894-2283
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PAUL TILLMAN
  • NPI Number: 1861537748
  • Taxonomy: 3336M0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2116568
LAB Type Pharmacy
Facility Name FIELDALE FARMS FAMILY HEALTH CARE CTR & PHARMACY
Street 184B PROFESSIONAL DR
City BALDWIN
State GA
ZIP 30511
Phone 866 894-2283
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/28/2024
Certificate Expiration Date 7/27/2026
Facility Type Pharmacy
Lab Director PAUL TILLMAN

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