11D2312113 CLIA NUMBER - PROMED DIAGNOSTICS LLC

Laboratory Demographics

  • CLIA Code: 11D2312113
  • Facility Name: PROMED DIAGNOSTICS LLC
  • Facility Address: 2912 OLD PELHAM ROAD
    PELHAM, GA
    ZIP 31779
  • Facility Phone: 615 864-2997
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: VALERIA FRAZIER
  • NPI Number: 1720802549
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2312113
LAB Type Mobile Laboratory
Facility Name PROMED DIAGNOSTICS LLC
Street 2912 OLD PELHAM ROAD
City PELHAM
State GA
ZIP 31779
Phone 615 864-2997
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/4/2024
Certificate Expiration Date 10/3/2026
Facility Type Mobile Laboratory
Lab Director VALERIA FRAZIER

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