11D2134980 CLIA NUMBER - DOUGLASVILLE CLINIC

Laboratory Demographics

  • CLIA Code: 11D2134980
  • Facility Name: DOUGLASVILLE CLINIC
  • Facility Address: 3666 HIGHWAY 5
    DOUGLASVILLE, GA
    ZIP 30135
  • Facility Phone: 404 564-7749
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: RUBY THOMAS
  • NPI Number: 1285066936
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2134980
LAB Type Federally Qualified Health Center
Facility Name DOUGLASVILLE CLINIC
Street 3666 HIGHWAY 5
City DOUGLASVILLE
State GA
ZIP 30135
Phone 404 564-7749
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/20/2025
Certificate Expiration Date 2/19/2027
Facility Type Federally Qualified Health Center
Lab Director RUBY THOMAS

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