11D0924903 CLIA NUMBER - NORTHSIDE FAMILY MEDICINE AND URGENT CARE

Laboratory Demographics

  • CLIA Code: 11D0924903
  • Facility Name: NORTHSIDE FAMILY MEDICINE AND URGENT CARE
  • Facility Address: 4800 OLDE TOWNE PARKWAY, SUITE 150
    MARIETTA, GA
    ZIP 30068
  • Facility Phone: 770 509-1025
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: THOMAS COLLENTINE
  • NPI Number: 1518905108
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0924903
LAB Type Physician Office
Facility Name NORTHSIDE FAMILY MEDICINE AND URGENT CARE
Street 4800 OLDE TOWNE PARKWAY, SUITE 150
City MARIETTA
State GA
ZIP 30068
Phone 770 509-1025
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 10/28/2023
Certificate Expiration Date 10/27/2025
Facility Type Physician Office
Lab Director THOMAS COLLENTINE

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