11D2208380 CLIA NUMBER - ROMULUS PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 11D2208380
  • Facility Name: ROMULUS PRIMARY CARE
  • Facility Address: 4940 GOVERNORS DRIVE SUITE 209
    FOREST PARK, GA
    ZIP 30297
  • Facility Phone: 770 277-1290
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: ROSE ROMULUS
  • NPI Number: 1972056380
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2208380
LAB Type Community Clinic
Facility Name ROMULUS PRIMARY CARE
Street 4940 GOVERNORS DRIVE SUITE 209
City FOREST PARK
State GA
ZIP 30297
Phone 770 277-1290
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/6/2025
Certificate Expiration Date 1/5/2027
Facility Type Community Clinic
Lab Director ROSE ROMULUS

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