11D2000721 CLIA NUMBER - KAISER PERMANENTE DECATUR MEDICAL OFFICE - TSPMG

Laboratory Demographics

  • CLIA Code: 11D2000721
  • Facility Name: KAISER PERMANENTE DECATUR MEDICAL OFFICE - TSPMG
  • Facility Address: 201 W PONCE DELEON AVENUE
    DECATUR, GA
    ZIP 30030
  • Facility Phone: 404 687-7690
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JAMES C. GAUTHIER
  • NPI Number: 1871823328
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 11D2000721
LAB Type Physician Office
Facility Name KAISER PERMANENTE DECATUR MEDICAL OFFICE - TSPMG
Street 201 W PONCE DELEON AVENUE
City DECATUR
State GA
ZIP 30030
Phone 404 687-7690
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 12/4/2023
Certificate Expiration Date 12/3/2025
Facility Type Physician Office
Lab Director JAMES C. GAUTHIER

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