11D0961280 CLIA NUMBER - NORTHSIDE HOSPITAL, INC - GCS/MACON

Laboratory Demographics

  • CLIA Code: 11D0961280
  • Facility Name: NORTHSIDE HOSPITAL, INC - GCS/MACON
  • Facility Address: 308 COLISEUM DRIVE, SUITE 120
    MACON, GA
    ZIP 31217
  • Facility Phone: 912 745-6130
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: DR. PREMILA MALHOTRA
  • NPI Number: 1326007089
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D0961280
LAB Type Physician Office
Facility Name NORTHSIDE HOSPITAL, INC - GCS/MACON
Street 308 COLISEUM DRIVE, SUITE 120
City MACON
State GA
ZIP 31217
Phone 912 745-6130
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 11/20/2023
Certificate Expiration Date 11/19/2025
Facility Type Physician Office
Lab Director DR. PREMILA MALHOTRA

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