11D2208235 CLIA NUMBER - LEGACY MEDICAL LLC

Laboratory Demographics

  • CLIA Code: 11D2208235
  • Facility Name: LEGACY MEDICAL LLC
  • Facility Address: 5422 CUMMING HIGHWAY NE SUITE 104
    SUGAR HILL, GA
    ZIP 30518
  • Facility Phone: 678 765-7147
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: COLETTE D. BULLOCK
  • NPI Number: 1750846648
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2208235
LAB Type Physician Office
Facility Name LEGACY MEDICAL LLC
Street 5422 CUMMING HIGHWAY NE SUITE 104
City SUGAR HILL
State GA
ZIP 30518
Phone 678 765-7147
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/5/2025
Certificate Expiration Date 1/4/2027
Facility Type Physician Office
Lab Director COLETTE D. BULLOCK

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