11D2032281 CLIA NUMBER - KAISER PERMANENTE ATHENS MEDICAL OFFICE

Laboratory Demographics

  • CLIA Code: 11D2032281
  • Facility Name: KAISER PERMANENTE ATHENS MEDICAL OFFICE
  • Facility Address: 2142 W BROAD STREET, BLDG 200, 1ST FL
    ATHENS, GA
    ZIP 30606
  • Facility Phone: 706 583-5000
  • Facility Type: Health Main. Organization
  • Facility Type: Microscopy
  • Lab Director: DANIEL GRIZZLE
  • NPI Number: 1760750137
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 11D2032281
LAB Type Health Main. Organization
Facility Name KAISER PERMANENTE ATHENS MEDICAL OFFICE
Street 2142 W BROAD STREET, BLDG 200, 1ST FL
City ATHENS
State GA
ZIP 30606
Phone 706 583-5000
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 11/8/2023
Certificate Expiration Date 11/7/2025
Facility Type Health Main. Organization
Lab Director DANIEL GRIZZLE

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