11D2121252 CLIA NUMBER - PEACHTREE IMMEDIATE CARE

Laboratory Demographics

  • CLIA Code: 11D2121252
  • Facility Name: PEACHTREE IMMEDIATE CARE
  • Facility Address: 1495 LAFAYETTE PARKWAY
    LAGRANGE, GA
    ZIP 30241
  • Facility Phone: 706 882-7822
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMES A. YOST
  • NPI Number: 1316433477
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2121252
LAB Type Physician Office
Facility Name PEACHTREE IMMEDIATE CARE
Street 1495 LAFAYETTE PARKWAY
City LAGRANGE
State GA
ZIP 30241
Phone 706 882-7822
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/2/2024
Certificate Expiration Date 11/1/2026
Facility Type Physician Office
Lab Director JAMES A. YOST

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