11D2228485 CLIA NUMBER - PRIME DIRECT CARE & MEDSPA

Laboratory Demographics

  • CLIA Code: 11D2228485
  • Facility Name: PRIME DIRECT CARE & MEDSPA
  • Facility Address: 401 DIVIDEND DRIVE, SUITE G
    PEACHTREE CITY, GA
    ZIP 30269
  • Facility Phone: 678 907-0663
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRIDGETT RANDOLPH
  • NPI Number: 1881358125
  • Taxonomy: 163WG0000X - Registered Nurse

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CLIA Record

Field Name Field Value
CLIA Number 11D2228485
LAB Type Physician Office
Facility Name PRIME DIRECT CARE & MEDSPA
Street 401 DIVIDEND DRIVE, SUITE G
City PEACHTREE CITY
State GA
ZIP 30269
Phone 678 907-0663
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/28/2025
Certificate Expiration Date 6/27/2027
Facility Type Physician Office
Lab Director BRIDGETT RANDOLPH

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