11D0900654 CLIA NUMBER - JAMES E GLEASON JR MDPC

Laboratory Demographics

  • CLIA Code: 11D0900654
  • Facility Name: JAMES E GLEASON JR MDPC
  • Facility Address: 33 UPPER RIVERDALE ROAD SUITE 118
    RIVERDALE, GA
    ZIP 30274
  • Facility Phone: 770 994-6969
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JAMES E. GLEASON JR
  • NPI Number: 1780649368
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0900654
LAB Type Physician Office
Facility Name JAMES E GLEASON JR MDPC
Street 33 UPPER RIVERDALE ROAD SUITE 118
City RIVERDALE
State GA
ZIP 30274
Phone 770 994-6969
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/3/2025
Certificate Expiration Date 5/2/2027
Facility Type Physician Office
Lab Director JAMES E. GLEASON JR

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