11D0892502 CLIA NUMBER - MOUNTAIN INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 11D0892502
  • Facility Name: MOUNTAIN INTERNAL MEDICINE
  • Facility Address: 835 AUSTIN DRIVE
    DEMOREST, GA
    ZIP 30535
  • Facility Phone: 706 754-8518
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: WILLIAM R. WEAVER
  • NPI Number: 1033187711
  • Taxonomy: 207R00000X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D0892502
LAB Type Physician Office
Facility Name MOUNTAIN INTERNAL MEDICINE
Street 835 AUSTIN DRIVE
City DEMOREST
State GA
ZIP 30535
Phone 706 754-8518
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/30/2024
Certificate Expiration Date 9/29/2026
Facility Type Physician Office
Lab Director WILLIAM R. WEAVER

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 3/20/2025