11D2143812 CLIA NUMBER - OASIS PRIMARY CARE CLINIC

Laboratory Demographics

  • CLIA Code: 11D2143812
  • Facility Name: OASIS PRIMARY CARE CLINIC
  • Facility Address: 9639 HIGHWAY 5, SUITE 103
    DOUGLASVILLE, GA
    ZIP 30135
  • Facility Phone: 770 757-3481
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: ZEBULON D. FOREMAN
  • NPI Number: 1376050773
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 11D2143812
LAB Type Practitioner Other
Facility Name OASIS PRIMARY CARE CLINIC
Street 9639 HIGHWAY 5, SUITE 103
City DOUGLASVILLE
State GA
ZIP 30135
Phone 770 757-3481
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/6/2024
Certificate Expiration Date 2/5/2026
Facility Type Practitioner Other
Lab Director ZEBULON D. FOREMAN

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