11D2163287 CLIA NUMBER - PREMIER PRIMARY CARE, LLC

Laboratory Demographics

  • CLIA Code: 11D2163287
  • Facility Name: PREMIER PRIMARY CARE, LLC
  • Facility Address: 2121 FOUNTAIN DRIVE, SUITE A
    SNELLVILLE, GA
    ZIP 30078
  • Facility Phone: 404 822-2944
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOSE DOMINGUEZ
  • NPI Number: 1154887925
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2163287
LAB Type Physician Office
Facility Name PREMIER PRIMARY CARE, LLC
Street 2121 FOUNTAIN DRIVE, SUITE A
City SNELLVILLE
State GA
ZIP 30078
Phone 404 822-2944
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/12/2025
Certificate Expiration Date 3/11/2027
Facility Type Physician Office
Lab Director JOSE DOMINGUEZ

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