11D2023801 CLIA NUMBER - LONGSTREET FAMILY MED DAHLONEGA

Laboratory Demographics

  • CLIA Code: 11D2023801
  • Facility Name: LONGSTREET FAMILY MED DAHLONEGA
  • Facility Address: 23 TIPTON DRIVE
    DAHLONEGA, GA
    ZIP 30533
  • Facility Phone: 706 867-6505
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL J. MULBERRY
  • NPI Number: 1013079532
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2023801
LAB Type Physician Office
Facility Name LONGSTREET FAMILY MED DAHLONEGA
Street 23 TIPTON DRIVE
City DAHLONEGA
State GA
ZIP 30533
Phone 706 867-6505
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/3/2025
Certificate Expiration Date 5/2/2027
Facility Type Physician Office
Lab Director MICHAEL J. MULBERRY

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