11D2070378 CLIA NUMBER - COMMONWEALTH PRIMARY CARE, LLC

Laboratory Demographics

  • CLIA Code: 11D2070378
  • Facility Name: COMMONWEALTH PRIMARY CARE, LLC
  • Facility Address: 1614 PEACHTREE PARKWAY
    CUMMING, GA
    ZIP 30041
  • Facility Phone: 678 455-2295
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAYASRI MALLAVARAPU
  • NPI Number: 1982033411
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2070378
LAB Type Physician Office
Facility Name COMMONWEALTH PRIMARY CARE, LLC
Street 1614 PEACHTREE PARKWAY
City CUMMING
State GA
ZIP 30041
Phone 678 455-2295
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/16/2023
Certificate Expiration Date 12/15/2025
Facility Type Physician Office
Lab Director JAYASRI MALLAVARAPU

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