11D2127540 CLIA NUMBER - PITTARD CLINIC

Laboratory Demographics

  • CLIA Code: 11D2127540
  • Facility Name: PITTARD CLINIC
  • Facility Address: 1678 FALLS ROAD
    TOCCOA, GA
    ZIP 30577
  • Facility Phone: 706 886-4420
  • Facility Type: Other - M A T PROGRAM
  • Facility Type: Waiver
  • Lab Director: CARL W. SMITH
  • NPI Number: 1912528696
  • Taxonomy: 261QM2800X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2127540
LAB Type Other - M A T PROGRAM
Facility Name PITTARD CLINIC
Street 1678 FALLS ROAD
City TOCCOA
State GA
ZIP 30577
Phone 706 886-4420
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/15/2025
Certificate Expiration Date 3/14/2027
Facility Type Other - M A T PROGRAM
Lab Director CARL W. SMITH

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