11D2198800 CLIA NUMBER - MOUNTAIN LAKES PHYSICIANS GROUP

Laboratory Demographics

  • CLIA Code: 11D2198800
  • Facility Name: MOUNTAIN LAKES PHYSICIANS GROUP
  • Facility Address: 338 STAGECOACH ROAD
    CLAYTON, GA
    ZIP 30525
  • Facility Phone: 706 782-0467
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: MICHAEL A. HOLLIFIELD
  • NPI Number: 1255905352
  • Taxonomy: 207X00000X - Orthopaedic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 11D2198800
LAB Type Rural Health Clinic
Facility Name MOUNTAIN LAKES PHYSICIANS GROUP
Street 338 STAGECOACH ROAD
City CLAYTON
State GA
ZIP 30525
Phone 706 782-0467
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/4/2024
Certificate Expiration Date 11/3/2026
Facility Type Rural Health Clinic
Lab Director MICHAEL A. HOLLIFIELD

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