CLIA lab
CLIA 11D1017659: Dacula Family Practice
Dacula, GA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 11D1017659 belongs to Dacula Family Practice in Dacula, GA.
Certificate of Waiver, effective October 1, 2025, expires September 30, 2027.
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
- October 1, 2025
- Certificate expiration
- September 30, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- October 1, 2003
- Facility type
- Physician office
- 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
- 11D1017659
- Lab name
- Dacula Family Practice
- Address
- 2850 Hog Mountain Road Suite 102, Dacula, GA 30019
- Phone
- (770) 614-5454
- Fax
- (678) 814-0488
Annual test volume the lab reported
- Waived tests
- 220
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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Related
Questions
What is the CLIA number for Dacula Family Practice in Dacula?
11D1017659, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Dacula Family Practice hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 11D1017659 expire?
The CMS file lists September 30, 2027 as the certificate expiration date; the certificate took effect October 1, 2025.