11D2177966 CLIA NUMBER - AIR EVAC LIFETEAM AEL 153

Laboratory Demographics

  • CLIA Code: 11D2177966
  • Facility Name: AIR EVAC LIFETEAM AEL 153
  • Facility Address: 125 PROMENADE PARKWAY
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 916 342-9384
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: FRANK PALOMBO
  • NPI Number: 1356980650
  • Taxonomy: 3416A0800X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 11D2177966
LAB Type Mobile Laboratory
Facility Name AIR EVAC LIFETEAM AEL 153
Street 125 PROMENADE PARKWAY
City FAYETTEVILLE
State GA
ZIP 30214
Phone 916 342-9384
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/23/2024
Certificate Expiration Date 1/22/2026
Facility Type Mobile Laboratory
Lab Director FRANK PALOMBO

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