11D1062227 CLIA NUMBER - PRIMARY MEDICAL CARE GROUP

Laboratory Demographics

  • CLIA Code: 11D1062227
  • Facility Name: PRIMARY MEDICAL CARE GROUP
  • Facility Address: 5322 SNAPFINGER PARK DRIVE
    DECATUR, GA
    ZIP 30035
  • Facility Phone: 404 289-9784
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: A IBRAHEEM MUSIBAU
  • NPI Number: 1689737603
  • Taxonomy: 207QA0505X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1062227
LAB Type Physician Office
Facility Name PRIMARY MEDICAL CARE GROUP
Street 5322 SNAPFINGER PARK DRIVE
City DECATUR
State GA
ZIP 30035
Phone 404 289-9784
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Physician Office
Lab Director A IBRAHEEM MUSIBAU

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