11D2084372 CLIA NUMBER - PRIMARY CARE AT WHITE CIRCLE

Laboratory Demographics

  • CLIA Code: 11D2084372
  • Facility Name: PRIMARY CARE AT WHITE CIRCLE
  • Facility Address: 1810 WHITE CIRCLE NW, STE 105
    MARIETTA, GA
    ZIP 30066
  • Facility Phone: 678 797-6820
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CAROLYN SMALLWOOD
  • NPI Number: 1205262292
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2084372
LAB Type Physician Office
Facility Name PRIMARY CARE AT WHITE CIRCLE
Street 1810 WHITE CIRCLE NW, STE 105
City MARIETTA
State GA
ZIP 30066
Phone 678 797-6820
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/23/2024
Certificate Expiration Date 9/22/2026
Facility Type Physician Office
Lab Director CAROLYN SMALLWOOD

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