11D0258000 CLIA NUMBER - MED SOUTH ASSOCIATES PC

Laboratory Demographics

  • CLIA Code: 11D0258000
  • Facility Name: MED SOUTH ASSOCIATES PC
  • Facility Address: 483 UPPER RIVERDALE ROAD, SUITE G
    RIVERDALE, GA
    ZIP 30274
  • Facility Phone: 770 996-9400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RICHARD WRIGHT
  • NPI Number: 1508057589
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0258000
LAB Type Physician Office
Facility Name MED SOUTH ASSOCIATES PC
Street 483 UPPER RIVERDALE ROAD, SUITE G
City RIVERDALE
State GA
ZIP 30274
Phone 770 996-9400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/4/2025
Certificate Expiration Date 8/3/2027
Facility Type Physician Office
Lab Director RICHARD WRIGHT

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