11D1023880 CLIA NUMBER - INFECTIOUS DISEASE PROFESSIONAL

Laboratory Demographics

CLIA Number: 11D1023880

Facility Name: INFECTIOUS DISEASE PROFESSIONAL

Facility Address:
1400 NORTHSIDE FORSYTH DRIVE, SUITE 310
CUMMING, GA
ZIP 30041
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Facility Phone Number: 404 488-9839

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1174613459

Taxonomy: 207RI0200X - Internal Medicine
An internist who deals with infectious diseases of all types and in all organ systems. Conditions requiring selective use of antibiotics call for this special skill. This physician often diagnoses and treats AIDS patients and patients with fevers which have not been explained. Infectious disease specialists may also have expertise in preventive medicine and travel medicine.

CLIA Record

Field Name	Field Value
CLIA Number	11D1023880
LAB Type	Physician Office
Facility Name	INFECTIOUS DISEASE PROFESSIONAL
Street	1400 NORTHSIDE FORSYTH DRIVE, SUITE 310
City	CUMMING
State	GA
ZIP	30041
Phone	404 488-9839
CertificateType	3
CertificateEffectiveDate	9/30/2022
CertificateExpirationDate	9/29/2024
FacilityType	PPMP

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This page was last updated on: 4/23/2024