11D2041554 CLIA NUMBER - EASTSIDE ORTHOCARE

Laboratory Demographics

  • CLIA Code: 11D2041554
  • Facility Name: EASTSIDE ORTHOCARE
  • Facility Address: 2121 FOUNTAIN DRIVE, #E
    SNELLVILLE, GA
    ZIP 30078
  • Facility Phone: 770 978-1422
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CRAIG M. MINES
  • NPI Number: 1447398086
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 11D2041554
LAB Type Physician Office
Facility Name EASTSIDE ORTHOCARE
Street 2121 FOUNTAIN DRIVE, #E
City SNELLVILLE
State GA
ZIP 30078
Phone 770 978-1422
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/24/2024
Certificate Expiration Date 5/23/2026
Facility Type Physician Office
Lab Director CRAIG M. MINES

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