11D2043009 CLIA NUMBER - SOUTH SIDE FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 11D2043009
  • Facility Name: SOUTH SIDE FAMILY PRACTICE
  • Facility Address: 5898 JONESBORO ROAD
    MORROW, GA
    ZIP 30260
  • Facility Phone: (770) 629-5410
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: EVELYN I. ONUNKA
  • NPI Number: 1720385925
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 11D2043009
LAB Type Practitioner Other
Facility Name SOUTH SIDE FAMILY PRACTICE
Street 5898 JONESBORO ROAD
City MORROW
State GA
ZIP 30260
Phone 7706295410
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/25/2024
Certificate Expiration Date 6/24/2026
Facility Type Practitioner Other
Lab Director EVELYN I. ONUNKA

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This page was last updated on: 5/18/2026