CLIA lab
CLIA 11D0984217: Kroger Pharmacy #629
Cartersville, GA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 11D0984217 belongs to Kroger Pharmacy #629 in Cartersville, GA.
Certificate of Waiver, effective December 17, 2024, expires December 16, 2026.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- December 17, 2024
- Certificate expiration
- December 16, 2026
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- March 16, 2001
- Facility type
- Pharmacy
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 11D0984217
- Lab name
- Kroger Pharmacy #629
- Address
- 125 East Main Street, SE, Cartersville, GA 30121
- Phone
- (770) 386-8160
- Fax
- (770) 387-0694
Annual test volume the lab reported
- Waived tests
- 300
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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- Alan Kozarsky, MDCertificate of Waiver, Physician office11D2190849
- Amedisys Hospice Care of CartersvilleCertificate of Waiver, Hospice11D1078954
- Atrium Health Floyd Primary CareCertificate of Waiver, Physician office11D0922666
- Bartow County Fire and Emergency ServicesCertificate of Waiver, Ambulance11D2197707
Related
Questions
What is the CLIA number for Kroger Pharmacy #629 in Cartersville?
11D0984217, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Kroger Pharmacy #629 hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 11D0984217 expire?
The CMS file lists December 16, 2026 as the certificate expiration date; the certificate took effect December 17, 2024.