11D1001028 CLIA NUMBER - MIDDLE GEORGIA PRIMARY CARE PC

Laboratory Demographics

  • CLIA Code: 11D1001028
  • Facility Name: MIDDLE GEORGIA PRIMARY CARE PC
  • Facility Address: 1115 MORNINGSIDE DRIVE
    PERRY, GA
    ZIP 31069
  • Facility Phone: 478 988-3060
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: APPAVUCHETTY SOUNDAPPAN MD
  • NPI Number: 1699226001
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 11D1001028
LAB Type Physician Office
Facility Name MIDDLE GEORGIA PRIMARY CARE PC
Street 1115 MORNINGSIDE DRIVE
City PERRY
State GA
ZIP 31069
Phone 478 988-3060
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/28/2024
Certificate Expiration Date 6/27/2026
Facility Type Physician Office
Lab Director APPAVUCHETTY SOUNDAPPAN MD

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