11D1004979 CLIA NUMBER - NORTHSIDE LITHONIA PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 11D1004979
  • Facility Name: NORTHSIDE LITHONIA PRIMARY CARE
  • Facility Address: 6000 HILLANDALE DR. SUITE 100
    LITHONIA, GA
    ZIP 30058
  • Facility Phone: 678 418-2120
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SIBYL DUNCAN
  • NPI Number: 1871669994
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1004979
LAB Type Physician Office
Facility Name NORTHSIDE LITHONIA PRIMARY CARE
Street 6000 HILLANDALE DR. SUITE 100
City LITHONIA
State GA
ZIP 30058
Phone 678 418-2120
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/10/2024
Certificate Expiration Date 10/9/2026
Facility Type Physician Office
Lab Director SIBYL DUNCAN

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