11D2291846 CLIA NUMBER - LTCC ENTERPRISES, LLC

Laboratory Demographics

  • CLIA Code: 11D2291846
  • Facility Name: LTCC ENTERPRISES, LLC
  • Facility Address: 933 N HAIRSTON ROAD, #4
    STONE MOUNTAIN, GA
    ZIP 30058
  • Facility Phone: 404 500-0087
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: CARMEN COOPER
  • NPI Number: 1508648536
  • Taxonomy: 246RP1900X - Technician, Pathology

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CLIA Record

Field Name Field Value
CLIA Number 11D2291846
LAB Type Independent
Facility Name LTCC ENTERPRISES, LLC
Street 933 N HAIRSTON ROAD, #4
City STONE MOUNTAIN
State GA
ZIP 30058
Phone 404 500-0087
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/17/2023
Certificate Expiration Date 10/16/2025
Facility Type Independent
Lab Director CARMEN COOPER

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