11D0980346 CLIA NUMBER - SOUTHSIDE INTERNAL MEDICINE PC

Laboratory Demographics

  • CLIA Code: 11D0980346
  • Facility Name: SOUTHSIDE INTERNAL MEDICINE PC
  • Facility Address: 7384 HIGHWAY 85
    RIVERDALE, GA
    ZIP 30274
  • Facility Phone: 770 997-6644
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CASIMIR C. OKORO MD
  • NPI Number: 1740583194
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0980346
LAB Type Physician Office
Facility Name SOUTHSIDE INTERNAL MEDICINE PC
Street 7384 HIGHWAY 85
City RIVERDALE
State GA
ZIP 30274
Phone 770 997-6644
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 CASIMIR C. OKORO MD

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