11D1023880 CLIA NUMBER - INFECTIOUS DISEASE PROFESSIONAL

Laboratory Demographics

  • CLIA Code: 11D1023880
  • Facility Name: INFECTIOUS DISEASE PROFESSIONAL
  • Facility Address: 1400 NORTHSIDE FORSYTH DRIVE, SUITE 310
    CUMMING, GA
    ZIP 30041
  • Facility Phone: 404 488-9839
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. MADHAVI RAYAPUDI
  • NPI Number: 1174613459
  • Taxonomy: 207RI0200X - Internal Medicine

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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
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 9/30/2024
Certificate Expiration Date 9/29/2026
Facility Type Physician Office
Lab Director DR. MADHAVI RAYAPUDI

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