11D0927068 CLIA NUMBER - SOUTHSIDE MEDICAL CENTER INC

Laboratory Demographics

CLIA Number: 11D0927068

Facility Name: SOUTHSIDE MEDICAL CENTER INC

Facility Address:
1046 RIDGE AVENUE SOUTHWEST
ATLANTA, GA
ZIP 30315
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Facility Phone Number: 404 688-1350

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1548750573

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D0927068
LAB Type	Community Clinic
Facility Name	SOUTHSIDE MEDICAL CENTER INC
Street	1046 RIDGE AVENUE SOUTHWEST
City	ATLANTA
State	GA
ZIP	30315
Phone	404 688-1350
CertificateType	3
CertificateEffectiveDate	6/11/2023
CertificateExpirationDate	6/10/2025
FacilityType	PPMP

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This page was last updated on: 4/23/2024