11D2119969 CLIA NUMBER - FP-PEACHTREE IMMEDIATE CARE

Laboratory Demographics

  • CLIA Code: 11D2119969
  • Facility Name: FP-PEACHTREE IMMEDIATE CARE
  • Facility Address: 1275 HIGHWAY 54 W, SUITE 201
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 770 461-3776
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMES YOST
  • NPI Number: 1306035126
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 11D2119969
LAB Type Physician Office
Facility Name FP-PEACHTREE IMMEDIATE CARE
Street 1275 HIGHWAY 54 W, SUITE 201
City FAYETTEVILLE
State GA
ZIP 30214
Phone 770 461-3776
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/7/2024
Certificate Expiration Date 10/6/2026
Facility Type Physician Office
Lab Director JAMES YOST

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