11D2295789 CLIA NUMBER - MEND PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 11D2295789
  • Facility Name: MEND PRIMARY CARE
  • Facility Address: 2256 NORTHLAKE PRIMARY 204 A
    TUCKER, GA
    ZIP 30084
  • Facility Phone: 404 509-0019
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TIHITINA YIGZAW
  • NPI Number: 1457131526
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2295789
LAB Type Physician Office
Facility Name MEND PRIMARY CARE
Street 2256 NORTHLAKE PRIMARY 204 A
City TUCKER
State GA
ZIP 30084
Phone 404 509-0019
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/18/2023
Certificate Expiration Date 12/17/2025
Facility Type Physician Office
Lab Director TIHITINA YIGZAW

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