11D0262329 CLIA NUMBER - SIVARAMA K MEDURI MD PULMONARY DISEASES

Laboratory Demographics

  • CLIA Code: 11D0262329
  • Facility Name: SIVARAMA K MEDURI MD PULMONARY DISEASES
  • Facility Address: 1421 ROSS DRIVE, SUITE 3
    DALTON, GA
    ZIP 30720
  • Facility Phone: (706) 226-1300
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SIVARAMA K. MEDURI
  • NPI Number: 1508882945
  • Taxonomy: 207RP1001X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0262329
LAB Type Physician Office
Facility Name SIVARAMA K MEDURI MD PULMONARY DISEASES
Street 1421 ROSS DRIVE, SUITE 3
City DALTON
State GA
ZIP 30720
Phone 7062261300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/20/2026
Certificate Expiration Date 2/19/2028
Facility Type Physician Office
Lab Director SIVARAMA K. MEDURI

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This page was last updated on: 5/18/2026