11D2217787 CLIA NUMBER - SHITTU FAMILY PRACTICE, LLC

Laboratory Demographics

  • CLIA Code: 11D2217787
  • Facility Name: SHITTU FAMILY PRACTICE, LLC
  • Facility Address: 213 BANKS STATION
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 347 784-5788
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SITOU TAWA KALYTOU
  • NPI Number: 1194331439
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 11D2217787
LAB Type Physician Office
Facility Name SHITTU FAMILY PRACTICE, LLC
Street 213 BANKS STATION
City FAYETTEVILLE
State GA
ZIP 30214
Phone 347 784-5788
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2025
Certificate Expiration Date 3/23/2027
Facility Type Physician Office
Lab Director SITOU TAWA KALYTOU

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