11D0959730 CLIA NUMBER - WEST COBB INTERNAL MEDICINE PC

Laboratory Demographics

  • CLIA Code: 11D0959730
  • Facility Name: WEST COBB INTERNAL MEDICINE PC
  • Facility Address: 5077 DALLAS HIGHWAY, SUITE 315
    POWDER SPRINGS, GA
    ZIP 30127
  • Facility Phone: 770 218-1880
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. CHIDAMBARAM RAGHAVAN
  • NPI Number: 1467524330
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0959730
LAB Type Physician Office
Facility Name WEST COBB INTERNAL MEDICINE PC
Street 5077 DALLAS HIGHWAY, SUITE 315
City POWDER SPRINGS
State GA
ZIP 30127
Phone 770 218-1880
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/19/2025
Certificate Expiration Date 4/18/2027
Facility Type Physician Office
Lab Director DR. CHIDAMBARAM RAGHAVAN

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