11D2154590 CLIA NUMBER - HIGHLANDS INTERNAL MEDICINE, PC

Laboratory Demographics

  • CLIA Code: 11D2154590
  • Facility Name: HIGHLANDS INTERNAL MEDICINE, PC
  • Facility Address: 156 NORTH MAIN STREET
    CLAYTON, GA
    ZIP 30525
  • Facility Phone: 706 212-0390
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWARD FREDERICKSON
  • NPI Number: 1346728375
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2154590
LAB Type Physician Office
Facility Name HIGHLANDS INTERNAL MEDICINE, PC
Street 156 NORTH MAIN STREET
City CLAYTON
State GA
ZIP 30525
Phone 706 212-0390
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/17/2024
Certificate Expiration Date 9/16/2026
Facility Type Physician Office
Lab Director EDWARD FREDERICKSON

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