11D2261409 CLIA NUMBER - PHOENIX EMERGENCY MEDICAL SERVICES, LLC

Laboratory Demographics

  • CLIA Code: 11D2261409
  • Facility Name: PHOENIX EMERGENCY MEDICAL SERVICES, LLC
  • Facility Address: 1625 HWY 42 N
    MCDONOUGH, GA
    ZIP 30253
  • Facility Phone: 770 914-5512
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: ROB W. LUNSFORD
  • NPI Number: 1225479744
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 11D2261409
LAB Type Ambulance
Facility Name PHOENIX EMERGENCY MEDICAL SERVICES, LLC
Street 1625 HWY 42 N
City MCDONOUGH
State GA
ZIP 30253
Phone 770 914-5512
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/31/2024
Certificate Expiration Date 5/30/2026
Facility Type Ambulance
Lab Director ROB W. LUNSFORD

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