11D2003499 CLIA NUMBER - OCONEE PRIMARY CARE, LLC

Laboratory Demographics

  • CLIA Code: 11D2003499
  • Facility Name: OCONEE PRIMARY CARE, LLC
  • Facility Address: 1624 MARS HILL ROAD, SUITE B
    WATKINSVILLE, GA
    ZIP 30677
  • Facility Phone: 706 310-1030
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: KEN PARK
  • NPI Number: 1275860900
  • Taxonomy: 207R00000X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2003499
LAB Type Physician Office
Facility Name OCONEE PRIMARY CARE, LLC
Street 1624 MARS HILL ROAD, SUITE B
City WATKINSVILLE
State GA
ZIP 30677
Phone 706 310-1030
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 2/11/2024
Certificate Expiration Date 2/10/2026
Facility Type Physician Office
Lab Director KEN PARK

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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