11D2160839 CLIA NUMBER - PRIMARY PEDIATRICS, BONAIRE

Laboratory Demographics

  • CLIA Code: 11D2160839
  • Facility Name: PRIMARY PEDIATRICS, BONAIRE
  • Facility Address: 104 BLUFF CHASE, SUITE A
    BONAIRE, GA
    ZIP 31005
  • Facility Phone: 478 741-3007
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: WILLIAM LEE TIFT
  • NPI Number: 1477638575
  • Taxonomy: 174400000X - Specialist

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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
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 11/7/2023
Certificate Expiration Date 11/6/2025
Facility Type Physician Office
Lab Director WILLIAM LEE TIFT

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