11D0976863 CLIA NUMBER - PRIME PEDIATRICS PC

Laboratory Demographics

  • CLIA Code: 11D0976863
  • Facility Name: PRIME PEDIATRICS PC
  • Facility Address: 1610 BROADRICK DRIVE
    DALTON, GA
    ZIP 30720
  • Facility Phone: 706 279-1994
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: AYMAN RIFAI
  • NPI Number: 1053578450
  • Taxonomy: 2080A0000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D0976863
LAB Type Physician Office
Facility Name PRIME PEDIATRICS PC
Street 1610 BROADRICK DRIVE
City DALTON
State GA
ZIP 30720
Phone 706 279-1994
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 11/2/2024
Certificate Expiration Date 11/1/2026
Facility Type Physician Office
Lab Director AYMAN RIFAI

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