11D0933005 CLIA NUMBER - SOUTHSIDE KIDNEY CLINIC PC

Laboratory Demographics

  • CLIA Code: 11D0933005
  • Facility Name: SOUTHSIDE KIDNEY CLINIC PC
  • Facility Address: 3580 CAMERON PARKWAY
    STOCKBRIDGE, GA
    ZIP 30281
  • Facility Phone: 770 996-6446
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MOHAMAD M. KASSEM MD
  • NPI Number: 1659398600
  • Taxonomy: 207RN0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0933005
LAB Type Physician Office
Facility Name SOUTHSIDE KIDNEY CLINIC PC
Street 3580 CAMERON PARKWAY
City STOCKBRIDGE
State GA
ZIP 30281
Phone 770 996-6446
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 9/3/2025
Certificate Expiration Date 9/2/2027
Facility Type Physician Office
Lab Director MOHAMAD M. KASSEM MD

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