11D1083565 CLIA NUMBER - BUCKHEAD CONCIERGE INTERNAL MEDICINE LLC

Laboratory Demographics

  • CLIA Code: 11D1083565
  • Facility Name: BUCKHEAD CONCIERGE INTERNAL MEDICINE LLC
  • Facility Address: 91 WEST WIEUCA ROAD SUITE 1000
    ATLANTA, GA
    ZIP 30342
  • Facility Phone: 404 257-5585
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWARD A. ESPINOSA DO
  • NPI Number: 1245400514
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1083565
LAB Type Physician Office
Facility Name BUCKHEAD CONCIERGE INTERNAL MEDICINE LLC
Street 91 WEST WIEUCA ROAD SUITE 1000
City ATLANTA
State GA
ZIP 30342
Phone 404 257-5585
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/6/2024
Certificate Expiration Date 5/5/2026
Facility Type Physician Office
Lab Director EDWARD A. ESPINOSA DO

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