11D2305935 CLIA NUMBER - ICECARE, LLC DBA VITALCARE EXPRESS

Laboratory Demographics

  • CLIA Code: 11D2305935
  • Facility Name: ICECARE, LLC DBA VITALCARE EXPRESS
  • Facility Address: 976 MANSELL ROAD
    ROSWELL, GA
    ZIP 30075
  • Facility Phone: 770 800-3277
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANTHONY C. IWELUNMOR
  • NPI Number: 1366202236
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2305935
LAB Type Physician Office
Facility Name ICECARE, LLC DBA VITALCARE EXPRESS
Street 976 MANSELL ROAD
City ROSWELL
State GA
ZIP 30075
Phone 770 800-3277
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/10/2024
Certificate Expiration Date 6/9/2026
Facility Type Physician Office
Lab Director ANTHONY C. IWELUNMOR

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