11D2221381 CLIA NUMBER - ICARE CLINIC & MEDSPA, LLC

Laboratory Demographics

  • CLIA Code: 11D2221381
  • Facility Name: ICARE CLINIC & MEDSPA, LLC
  • Facility Address: 4580 MEMORIAL DRIVE
    DECATUR, GA
    ZIP 30032
  • Facility Phone: 770 856-8988
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: SIKIRAT Y. OROPO
  • NPI Number: 1275124166
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 11D2221381
LAB Type Practitioner Other
Facility Name ICARE CLINIC & MEDSPA, LLC
Street 4580 MEMORIAL DRIVE
City DECATUR
State GA
ZIP 30032
Phone 770 856-8988
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/21/2025
Certificate Expiration Date 4/20/2027
Facility Type Practitioner Other
Lab Director SIKIRAT Y. OROPO

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