11D0868128 CLIA NUMBER - INFECTIOUS DISEASES ASSOCIATES

Laboratory Demographics

  • CLIA Code: 11D0868128
  • Facility Name: INFECTIOUS DISEASES ASSOCIATES
  • Facility Address: 6285 DON HASTINGS DR STE A
    RIVERDALE, GA
    ZIP 30274
  • Facility Phone: 770 991-1500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RICHARD C. PROKESCH
  • NPI Number: 1689881989
  • Taxonomy: 207RI0200X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0868128
LAB Type Physician Office
Facility Name INFECTIOUS DISEASES ASSOCIATES
Street 6285 DON HASTINGS DR STE A
City RIVERDALE
State GA
ZIP 30274
Phone 770 991-1500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director RICHARD C. PROKESCH

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