11D2052600 CLIA NUMBER - MED-SOUTH PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 11D2052600
  • Facility Name: MED-SOUTH PRIMARY CARE
  • Facility Address: 1240 EAGLES LANDING PARKWAY SUITE 100
    STOCKBRIDGE, GA
    ZIP 30281
  • Facility Phone: 770 506-0100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MS. KELLY PADGETT
  • NPI Number: 1245413715
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2052600
LAB Type Physician Office
Facility Name MED-SOUTH PRIMARY CARE
Street 1240 EAGLES LANDING PARKWAY SUITE 100
City STOCKBRIDGE
State GA
ZIP 30281
Phone 770 506-0100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/16/2024
Certificate Expiration Date 11/15/2026
Facility Type Physician Office
Lab Director MS. KELLY PADGETT

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