11D0256394 CLIA NUMBER - SHANNON MIZE MD PC

Laboratory Demographics

  • CLIA Code: 11D0256394
  • Facility Name: SHANNON MIZE MD PC
  • Facility Address: 208 HUDSON STREET
    CUMMING, GA
    ZIP 30040
  • Facility Phone: 770 887-5835
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHANNON MIZE
  • NPI Number: 1609885813
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0256394
LAB Type Physician Office
Facility Name SHANNON MIZE MD PC
Street 208 HUDSON STREET
City CUMMING
State GA
ZIP 30040
Phone 770 887-5835
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/11/2025
Certificate Expiration Date 10/10/2027
Facility Type Physician Office
Lab Director SHANNON MIZE

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