11D1009039 CLIA NUMBER - EASTSIDE INTERNAL MEDICINE LLC

Laboratory Demographics

  • CLIA Code: 11D1009039
  • Facility Name: EASTSIDE INTERNAL MEDICINE LLC
  • Facility Address: 2080 EASTSIDE DRIVE
    CONYERS, GA
    ZIP 30013
  • Facility Phone: 678 625-7800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SYED O. WASIM MD
  • NPI Number: 1437211703
  • Taxonomy: 207R00000X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D1009039
LAB Type Physician Office
Facility Name EASTSIDE INTERNAL MEDICINE LLC
Street 2080 EASTSIDE DRIVE
City CONYERS
State GA
ZIP 30013
Phone 678 625-7800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2024
Certificate Expiration Date 10/31/2026
Facility Type Physician Office
Lab Director SYED O. WASIM MD

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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