11D2307459 CLIA NUMBER - PRIMEDOC

Laboratory Demographics

  • CLIA Code: 11D2307459
  • Facility Name: PRIMEDOC
  • Facility Address: 3867 ROSWELL ROAD, NE, STE 100
    ATLANTA, GA
    ZIP 30342
  • Facility Phone: 706 408-0909
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MELVIN WILLIAMS
  • NPI Number: 1801639687
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2307459
LAB Type Physician Office
Facility Name PRIMEDOC
Street 3867 ROSWELL ROAD, NE, STE 100
City ATLANTA
State GA
ZIP 30342
Phone 706 408-0909
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/9/2024
Certificate Expiration Date 7/8/2026
Facility Type Physician Office
Lab Director MELVIN WILLIAMS

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