11D0722490 CLIA NUMBER - SOUTH DEKALB PRIMARY CARE PC

Laboratory Demographics

  • CLIA Code: 11D0722490
  • Facility Name: SOUTH DEKALB PRIMARY CARE PC
  • Facility Address: 1290 COLUMBIA DRIVE
    DECATUR, GA
    ZIP 30032
  • Facility Phone: 404 289-1952
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: LISA WELCH
  • NPI Number: 1063538924
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0722490
LAB Type Physician Office
Facility Name SOUTH DEKALB PRIMARY CARE PC
Street 1290 COLUMBIA DRIVE
City DECATUR
State GA
ZIP 30032
Phone 404 289-1952
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/23/2023
Certificate Expiration Date 12/22/2025
Facility Type Physician Office
Lab Director LISA WELCH

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This page was last updated on: 6/4/2025