11D2277398 CLIA NUMBER - GEM PRIMARY HEALTHCARE, LLC

Laboratory Demographics

  • CLIA Code: 11D2277398
  • Facility Name: GEM PRIMARY HEALTHCARE, LLC
  • Facility Address: 175 COUNTRY CLUB DRIVE, BUILDING 100 D
    STOCKBRIDGE, GA
    ZIP 30281
  • Facility Phone: 678 819-5497
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: GERALDINE E. MENCHION
  • NPI Number: 1457072647
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2277398
LAB Type Practitioner Other
Facility Name GEM PRIMARY HEALTHCARE, LLC
Street 175 COUNTRY CLUB DRIVE, BUILDING 100 D
City STOCKBRIDGE
State GA
ZIP 30281
Phone 678 819-5497
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/27/2025
Certificate Expiration Date 2/26/2027
Facility Type Practitioner Other
Lab Director GERALDINE E. MENCHION

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