11D2071830 CLIA NUMBER - WINGARD PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 11D2071830
  • Facility Name: WINGARD PRIMARY CARE
  • Facility Address: 1325 COMMERCE DRIVE, SUITE 200
    PEACHTREE CITY, GA
    ZIP 30269
  • Facility Phone: 770 692-7575
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: RAY B. BENNETT
  • NPI Number: 1326387820
  • Taxonomy: 207Q00000X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2071830
LAB Type Physician Office
Facility Name WINGARD PRIMARY CARE
Street 1325 COMMERCE DRIVE, SUITE 200
City PEACHTREE CITY
State GA
ZIP 30269
Phone 770 692-7575
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 1/21/2024
Certificate Expiration Date 1/20/2026
Facility Type Physician Office
Lab Director RAY B. BENNETT

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