11D2281547 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04164

Laboratory Demographics

  • CLIA Code: 11D2281547
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04164
  • Facility Address: 1680 OLD PENDERGRASS ROAD
    JEFFERSON, GA
    ZIP 30549
  • Facility Phone: (706) 367-9201
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANSLEY FELTMAN
  • NPI Number: 1447528039
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2281547
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04164
Street 1680 OLD PENDERGRASS ROAD
City JEFFERSON
State GA
ZIP 30549
Phone 7063679201
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 ANSLEY FELTMAN

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This page was last updated on: 5/18/2026