11D0902137 CLIA NUMBER - GEORGIA UROLOGY PA RIVERDALE

Laboratory Demographics

  • CLIA Code: 11D0902137
  • Facility Name: GEORGIA UROLOGY PA RIVERDALE
  • Facility Address: 33 UPPER RIVERDALE ROAD SUITE 105
    RIVERDALE, GA
    ZIP 30274
  • Facility Phone: 770 991-0020
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. DARRELL CARMEN
  • NPI Number: 1245250646
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 11D0902137
LAB Type Physician Office
Facility Name GEORGIA UROLOGY PA RIVERDALE
Street 33 UPPER RIVERDALE ROAD SUITE 105
City RIVERDALE
State GA
ZIP 30274
Phone 770 991-0020
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 7/7/2024
Certificate Expiration Date 7/6/2026
Facility Type Physician Office
Lab Director DR. DARRELL CARMEN

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