11D2119401 CLIA NUMBER - CAEDEL WELLNESS CENTER, LLC

Laboratory Demographics

  • CLIA Code: 11D2119401
  • Facility Name: CAEDEL WELLNESS CENTER, LLC
  • Facility Address: 101 DEVANT STREET, SUITE 803
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 678 216-0342
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CLAIRE K. WILLIE
  • NPI Number: 1306085402
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2119401
LAB Type Physician Office
Facility Name CAEDEL WELLNESS CENTER, LLC
Street 101 DEVANT STREET, SUITE 803
City FAYETTEVILLE
State GA
ZIP 30214
Phone 678 216-0342
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/27/2024
Certificate Expiration Date 9/26/2026
Facility Type Physician Office
Lab Director CLAIRE K. WILLIE

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