11D0683061 CLIA NUMBER - MT VERNON INTERNAL MEDICINE LLP

Laboratory Demographics

  • CLIA Code: 11D0683061
  • Facility Name: MT VERNON INTERNAL MEDICINE LLP
  • Facility Address: 755 MT VERNON HIGHWAY NE SUITE 400 ATTN MARQUETTA RUBALCADA
    ATLANTA, GA
    ZIP 30328
  • Facility Phone: 404 252-4100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHARON TINANOFF
  • NPI Number: 1811928054
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 11D0683061
LAB Type Physician Office
Facility Name MT VERNON INTERNAL MEDICINE LLP
Street 755 MT VERNON HIGHWAY NE SUITE 400 ATTN MARQUETTA RUBALCADA
City ATLANTA
State GA
ZIP 30328
Phone 404 252-4100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/16/2024
Certificate Expiration Date 9/15/2026
Facility Type Physician Office
Lab Director SHARON TINANOFF

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