11D2144678 CLIA NUMBER - OPTIMAL PERFORMANCE MEDICINE, LLC

Laboratory Demographics

  • CLIA Code: 11D2144678
  • Facility Name: OPTIMAL PERFORMANCE MEDICINE, LLC
  • Facility Address: 120 STONEBRIDGE PARKWAY, SUITE 430
    WOODSTOCK, GA
    ZIP 30189
  • Facility Phone: 678 205-0700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL G. SKARDASIS
  • NPI Number: 1346755386
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2144678
LAB Type Physician Office
Facility Name OPTIMAL PERFORMANCE MEDICINE, LLC
Street 120 STONEBRIDGE PARKWAY, SUITE 430
City WOODSTOCK
State GA
ZIP 30189
Phone 678 205-0700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/21/2024
Certificate Expiration Date 2/20/2026
Facility Type Physician Office
Lab Director MICHAEL G. SKARDASIS

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This page was last updated on: 3/20/2025