11D2189334 CLIA NUMBER - OM PRIMARY CARE, LLC

Laboratory Demographics

  • CLIA Code: 11D2189334
  • Facility Name: OM PRIMARY CARE, LLC
  • Facility Address: 4300 WESTBROOK ROAD, BUILDING #A
    SUWANEE, GA
    ZIP 30024
  • Facility Phone: 470 416-3424
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KINJAL KACHALIA
  • NPI Number: 1841800679
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2189334
LAB Type Physician Office
Facility Name OM PRIMARY CARE, LLC
Street 4300 WESTBROOK ROAD, BUILDING #A
City SUWANEE
State GA
ZIP 30024
Phone 470 416-3424
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/29/2024
Certificate Expiration Date 7/28/2026
Facility Type Physician Office
Lab Director KINJAL KACHALIA

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