11D2310418 CLIA NUMBER - PRIMA CENTER FOR PLASTIC SURGERY

Laboratory Demographics

  • CLIA Code: 11D2310418
  • Facility Name: PRIMA CENTER FOR PLASTIC SURGERY
  • Facility Address: 3096 PEACHTREE INDUSTRIAL BLVD
    DULUTH, GA
    ZIP 30097
  • Facility Phone: 770 495-1477
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: HANJOON SONG
  • NPI Number: 1114065935
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 11D2310418
LAB Type Ambulatory Surgery Center
Facility Name PRIMA CENTER FOR PLASTIC SURGERY
Street 3096 PEACHTREE INDUSTRIAL BLVD
City DULUTH
State GA
ZIP 30097
Phone 770 495-1477
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/4/2024
Certificate Expiration Date 9/3/2026
Facility Type Ambulatory Surgery Center
Lab Director HANJOON SONG

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