11D2281514 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05395

Laboratory Demographics

  • CLIA Code: 11D2281514
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05395
  • Facility Address: 2237 CASCADE ROAD, SW
    ATLANTA, GA
    ZIP 30311
  • Facility Phone: 404 756-5591
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: IDRISSE TETSADJIO
  • NPI Number: 1902903495
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2281514
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05395
Street 2237 CASCADE ROAD, SW
City ATLANTA
State GA
ZIP 30311
Phone 404 756-5591
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/9/2025
Certificate Expiration Date 5/8/2027
Facility Type Pharmacy
Lab Director IDRISSE TETSADJIO

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