11D0979039 CLIA NUMBER - CAEDEL MEDICAL GROUP, CP

Laboratory Demographics

  • CLIA Code: 11D0979039
  • Facility Name: CAEDEL MEDICAL GROUP, CP
  • Facility Address: 1324 HIGHWAY 138 SOUTH WEST
    RIVERDALE, GA
    ZIP 30296
  • Facility Phone: 770 907-4949
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CLAIRE K. WILLIE
  • NPI Number: 1710922075
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0979039
LAB Type Physician Office
Facility Name CAEDEL MEDICAL GROUP, CP
Street 1324 HIGHWAY 138 SOUTH WEST
City RIVERDALE
State GA
ZIP 30296
Phone 770 907-4949
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/17/2024
Certificate Expiration Date 11/16/2026
Facility Type Physician Office
Lab Director CLAIRE K. WILLIE

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