11D2148493 CLIA NUMBER - FP- PEACHTREE IMMEDIATE CARE-MTN

Laboratory Demographics

  • CLIA Code: 11D2148493
  • Facility Name: FP- PEACHTREE IMMEDIATE CARE-MTN
  • Facility Address: 450 14TH STREET, NW
    ATLANTA, GA
    ZIP 30318
  • Facility Phone: 404 480-9797
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMES YOST
  • NPI Number: 1396890844
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2148493
LAB Type Physician Office
Facility Name FP- PEACHTREE IMMEDIATE CARE-MTN
Street 450 14TH STREET, NW
City ATLANTA
State GA
ZIP 30318
Phone 404 480-9797
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/14/2024
Certificate Expiration Date 5/13/2026
Facility Type Physician Office
Lab Director JAMES YOST

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