11D2285307 CLIA NUMBER - MALOZERA PRIMARY CARE,LLC

Laboratory Demographics

  • CLIA Code: 11D2285307
  • Facility Name: MALOZERA PRIMARY CARE,LLC
  • Facility Address: 2809 PINE STREET
    UNADILLA, GA
    ZIP 31091
  • Facility Phone: 478 783-3610
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALEXANDER C. IBEZI-ENENDU
  • NPI Number: 1912544784
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2285307
LAB Type Physician Office
Facility Name MALOZERA PRIMARY CARE,LLC
Street 2809 PINE STREET
City UNADILLA
State GA
ZIP 31091
Phone 478 783-3610
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/11/2025
Certificate Expiration Date 7/10/2027
Facility Type Physician Office
Lab Director ALEXANDER C. IBEZI-ENENDU

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