11D0258919 CLIA NUMBER - BUCKHEAD INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 11D0258919
  • Facility Name: BUCKHEAD INTERNAL MEDICINE
  • Facility Address: 2021 PEACHTREE ROAD, SUITE 550
    ATLANTA, GA
    ZIP 30309
  • Facility Phone: 404 355-1966
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NAN R. MONAHAN
  • NPI Number: 1689740029
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0258919
LAB Type Physician Office
Facility Name BUCKHEAD INTERNAL MEDICINE
Street 2021 PEACHTREE ROAD, SUITE 550
City ATLANTA
State GA
ZIP 30309
Phone 404 355-1966
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/30/2024
Certificate Expiration Date 3/29/2026
Facility Type Physician Office
Lab Director NAN R. MONAHAN

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