11D2310659 CLIA NUMBER - EPITOME PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 11D2310659
  • Facility Name: EPITOME PRIMARY CARE
  • Facility Address: 631 CAMPBELL HILL STREET, NW, SUITE 200
    MARIETTA, GA
    ZIP 30060
  • Facility Phone: 770 727-6124
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KENNETTE ST-GOURDIN
  • NPI Number: 1023835782
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2310659
LAB Type Physician Office
Facility Name EPITOME PRIMARY CARE
Street 631 CAMPBELL HILL STREET, NW, SUITE 200
City MARIETTA
State GA
ZIP 30060
Phone 770 727-6124
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/8/2024
Certificate Expiration Date 9/7/2026
Facility Type Physician Office
Lab Director KENNETTE ST-GOURDIN

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