11D2007652 CLIA NUMBER - PERSONALIZED PRIMARYCARE OF ATLANTA, LLC

Laboratory Demographics

  • CLIA Code: 11D2007652
  • Facility Name: PERSONALIZED PRIMARYCARE OF ATLANTA, LLC
  • Facility Address: 57 EXECUTIVE PARK SOUTH, SUITE 390
    ATLANTA, GA
    ZIP 30329
  • Facility Phone: 404 997-6790
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JULIET MAVROMATIS
  • NPI Number: 1245380435
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 11D2007652
LAB Type Physician Office
Facility Name PERSONALIZED PRIMARYCARE OF ATLANTA, LLC
Street 57 EXECUTIVE PARK SOUTH, SUITE 390
City ATLANTA
State GA
ZIP 30329
Phone 404 997-6790
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/21/2024
Certificate Expiration Date 5/20/2026
Facility Type Physician Office
Lab Director JULIET MAVROMATIS

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