11D2229349 CLIA NUMBER - WALGREENS #17697

Laboratory Demographics

  • CLIA Code: 11D2229349
  • Facility Name: WALGREENS #17697
  • Facility Address: 192 1ST AVENUE
    ELLIJAY, GA
    ZIP 30540
  • Facility Phone: 706 635-2241
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAN DOWDA
  • NPI Number: 1750804589
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2229349
LAB Type Pharmacy
Facility Name WALGREENS #17697
Street 192 1ST AVENUE
City ELLIJAY
State GA
ZIP 30540
Phone 706 635-2241
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/12/2025
Certificate Expiration Date 7/11/2027
Facility Type Pharmacy
Lab Director JAN DOWDA

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