11D1015082 CLIA NUMBER - MAXA INTERNAL MEDICINE ASSOCIATES PC

Laboratory Demographics

  • CLIA Code: 11D1015082
  • Facility Name: MAXA INTERNAL MEDICINE ASSOCIATES PC
  • Facility Address: 3505 DULUTH PARK LANE, BDG 4 SUITE 400
    DULUTH, GA
    ZIP 30096
  • Facility Phone: 678 597-3180
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: RICHARD R. MAXA
  • NPI Number: 1902957152
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1015082
LAB Type Physician Office
Facility Name MAXA INTERNAL MEDICINE ASSOCIATES PC
Street 3505 DULUTH PARK LANE, BDG 4 SUITE 400
City DULUTH
State GA
ZIP 30096
Phone 678 597-3180
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 7/23/2025
Certificate Expiration Date 7/22/2027
Facility Type Physician Office
Lab Director RICHARD R. MAXA

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