11D0261374 CLIA NUMBER - NORTHEAST GEORGIA DIAGNOSTIC ASSOC AND CLINIC, LLC

Laboratory Demographics

  • CLIA Code: 11D0261374
  • Facility Name: NORTHEAST GEORGIA DIAGNOSTIC ASSOC AND CLINIC, LLC
  • Facility Address: 1240 JESSE JEWEL PARKWAY, SUITE 500 ATTN DIANA BETANCOURT OR AMANDA STANCIL
    GAINESVILLE, GA
    ZIP 30501
  • Facility Phone: 770 297-4905
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: ANDRE M. KALLAB
  • NPI Number: 1164885620
  • Taxonomy: 133V00000X - Dietitian, Registered

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CLIA Record

Field Name Field Value
CLIA Number 11D0261374
LAB Type Physician Office
Facility Name NORTHEAST GEORGIA DIAGNOSTIC ASSOC AND CLINIC, LLC
Street 1240 JESSE JEWEL PARKWAY, SUITE 500 ATTN DIANA BETANCOURT OR AMANDA STANCIL
City GAINESVILLE
State GA
ZIP 30501
Phone 770 297-4905
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 11/17/2023
Certificate Expiration Date 11/16/2025
Facility Type Physician Office
Lab Director ANDRE M. KALLAB

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