11D2282612 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05613

Laboratory Demographics

  • CLIA Code: 11D2282612
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05613
  • Facility Address: 21 NORTH CAROLINA STREET
    HARTWELL, GA
    ZIP 30643
  • Facility Phone: 706 376-3147
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JONATHAN BRANTLEY
  • NPI Number: 1891898631
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2282612
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05613
Street 21 NORTH CAROLINA STREET
City HARTWELL
State GA
ZIP 30643
Phone 706 376-3147
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/24/2025
Certificate Expiration Date 5/23/2027
Facility Type Pharmacy
Lab Director JONATHAN BRANTLEY

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