11D2263465 CLIA NUMBER - LOGANVILLE FIRE DEPARTMENT

Laboratory Demographics

  • CLIA Code: 11D2263465
  • Facility Name: LOGANVILLE FIRE DEPARTMENT
  • Facility Address: 4303 LAWRENCEVILLE ROAD
    LOGANVILLE, GA
    ZIP 30052
  • Facility Phone: 770 554-9693
  • Facility Type: Other - MED FIRST RESPOND VEHICLE
  • Facility Type: Waiver
  • Lab Director: TIMOTHY R. JOHNSON
  • NPI Number: 1649357120
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2263465
LAB Type Other - MED FIRST RESPOND VEHICLE
Facility Name LOGANVILLE FIRE DEPARTMENT
Street 4303 LAWRENCEVILLE ROAD
City LOGANVILLE
State GA
ZIP 30052
Phone 770 554-9693
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/29/2024
Certificate Expiration Date 6/28/2026
Facility Type Other - MED FIRST RESPOND VEHICLE
Lab Director TIMOTHY R. JOHNSON

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