11D2119917 CLIA NUMBER - FP - PEACHTREE IMMEDIATE CARE - GWI

Laboratory Demographics

  • CLIA Code: 11D2119917
  • Facility Name: FP - PEACHTREE IMMEDIATE CARE - GWI
  • Facility Address: 3551 SATELLITE BLVD
    DULUTH, GA
    ZIP 30096
  • Facility Phone: 770 476-3000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMES YOST
  • NPI Number: 1770754772
  • Taxonomy: 1223P0221X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 11D2119917
LAB Type Physician Office
Facility Name FP - PEACHTREE IMMEDIATE CARE - GWI
Street 3551 SATELLITE BLVD
City DULUTH
State GA
ZIP 30096
Phone 770 476-3000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/6/2024
Certificate Expiration Date 10/5/2026
Facility Type Physician Office
Lab Director JAMES YOST

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