11D2160839 CLIA NUMBER - PRIMARY PEDIATRICS, BONAIRE

Laboratory Demographics

CLIA Number: 11D2160839

Facility Name: PRIMARY PEDIATRICS, BONAIRE

Facility Address:
104 BLUFF CHASE, SUITE A
BONAIRE, GA
ZIP 31005
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Facility Phone Number: 478 741-3007

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1477638575

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	11D2160839
LAB Type	Physician Office
Facility Name	PRIMARY PEDIATRICS, BONAIRE
Street	104 BLUFF CHASE, SUITE A
City	BONAIRE
State	GA
ZIP	31005
Phone	478 741-3007
CertificateType	2
CertificateEffectiveDate	11/7/2023
CertificateExpirationDate	11/6/2025
FacilityType	Compliance

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This page was last updated on: 4/23/2024