11D0256261 CLIA NUMBER - PRIMARY CARE GROUP OF WEST GEORGIA PC

Laboratory Demographics

CLIA Number: 11D0256261

Facility Name: PRIMARY CARE GROUP OF WEST GEORGIA PC

Facility Address:
100 PROFESSIONAL PARK SUITE 204
CARROLLTON, GA
ZIP 30117
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Facility Phone Number: 770 834-3351

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1386635852

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	11D0256261
LAB Type	Physician Office
Facility Name	PRIMARY CARE GROUP OF WEST GEORGIA PC
Street	100 PROFESSIONAL PARK SUITE 204
City	CARROLLTON
State	GA
ZIP	30117
Phone	770 834-3351
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024