11D0256000 CLIA NUMBER - DEKALB-GWINNETT OB/GYN PC

Laboratory Demographics

  • CLIA Code: 11D0256000
  • Facility Name: DEKALB-GWINNETT OB/GYN PC
  • Facility Address: 4045 WETHERBURN WAY
    NORCROSS, GA
    ZIP 30092
  • Facility Phone: 770 449-8171
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JOSEPH L. TATE
  • NPI Number: 1659482883
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 11D0256000
LAB Type Physician Office
Facility Name DEKALB-GWINNETT OB/GYN PC
Street 4045 WETHERBURN WAY
City NORCROSS
State GA
ZIP 30092
Phone 770 449-8171
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 2/24/2024
Certificate Expiration Date 2/23/2026
Facility Type Physician Office
Lab Director JOSEPH L. TATE

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