11D1000577 CLIA NUMBER - NORTHSIDE PRIMARY CARE - ACWORTH

Laboratory Demographics

  • CLIA Code: 11D1000577
  • Facility Name: NORTHSIDE PRIMARY CARE - ACWORTH
  • Facility Address: 4450 CALIBRE CROSSING, SUITE 1224
    ACWORTH, GA
    ZIP 30101
  • Facility Phone: 770 974-6550
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANTHONY ALFANO
  • NPI Number: 1336146174
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1000577
LAB Type Physician Office
Facility Name NORTHSIDE PRIMARY CARE - ACWORTH
Street 4450 CALIBRE CROSSING, SUITE 1224
City ACWORTH
State GA
ZIP 30101
Phone 770 974-6550
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/1/2024
Certificate Expiration Date 6/30/2026
Facility Type Physician Office
Lab Director ANTHONY ALFANO

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