11D2263465 CLIA NUMBER - LOGANVILLE FIRE DEPARTMENT

Laboratory Demographics

CLIA Number: 11D2263465

Facility Name: LOGANVILLE FIRE DEPARTMENT

Facility Address:
4303 LAWRENCEVILLE ROAD
LOGANVILLE, GA
ZIP 30052
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Facility Phone Number: 770 554-9693

Facility Type: Other - MED FIRST RESPOND VEHICLE

Certificate Type: Waiver

NPI Number: 1649357120

Taxonomy: 261QE0700X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	6/29/2022
CertificateExpirationDate	6/28/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024