11D0976438 CLIA NUMBER - NORTHSIDE HOSPITAL, INC - GCS/MILLEDGEVILLE

Laboratory Demographics

  • CLIA Code: 11D0976438
  • Facility Name: NORTHSIDE HOSPITAL, INC - GCS/MILLEDGEVILLE
  • Facility Address: 111 FIELDSTONE DRIVE, SUITE 116
    MILLEDGEVILLE, GA
    ZIP 31061
  • Facility Phone: 478 453-1806
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: DR. PREMILA MALHOTRA
  • NPI Number: 1316124324
  • Taxonomy: 335E00000X - Prosthetic/Orthotic Supplier

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CLIA Record

Field Name Field Value
CLIA Number 11D0976438
LAB Type Physician Office
Facility Name NORTHSIDE HOSPITAL, INC - GCS/MILLEDGEVILLE
Street 111 FIELDSTONE DRIVE, SUITE 116
City MILLEDGEVILLE
State GA
ZIP 31061
Phone 478 453-1806
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 12/18/2023
Certificate Expiration Date 12/17/2025
Facility Type Physician Office
Lab Director DR. PREMILA MALHOTRA

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