11D1007099 CLIA NUMBER - BUFORD MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 11D1007099
  • Facility Name: BUFORD MEDICAL CLINIC
  • Facility Address: 4745 NELSON BROGDON BLVD, SUITE 200
    BUFORD, GA
    ZIP 30518
  • Facility Phone: 770 945-7676
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ANISH PATEL
  • NPI Number: 1407977457
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1007099
LAB Type Physician Office
Facility Name BUFORD MEDICAL CLINIC
Street 4745 NELSON BROGDON BLVD, SUITE 200
City BUFORD
State GA
ZIP 30518
Phone 770 945-7676
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/9/2024
Certificate Expiration Date 12/8/2026
Facility Type Physician Office
Lab Director ANISH PATEL

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