11D2069049 CLIA NUMBER - SWAROOP N NYSHAOHAM

Laboratory Demographics

  • CLIA Code: 11D2069049
  • Facility Name: SWAROOP N NYSHAOHAM
  • Facility Address: 1990 LUKKEN INDUSTRIAL DRIVE, WEST, SUITE C
    LAGRANGE, GA
    ZIP 30240
  • Facility Phone: (706) 883-8787
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. SWAAOOP N. NYSHADHAM
  • NPI Number: 1306892351
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 11D2069049
LAB Type Physician Office
Facility Name SWAROOP N NYSHAOHAM
Street 1990 LUKKEN INDUSTRIAL DRIVE, WEST, SUITE C
City LAGRANGE
State GA
ZIP 30240
Phone 7068838787
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/18/2025
Certificate Expiration Date 11/17/2027
Facility Type Physician Office
Lab Director DR. SWAAOOP N. NYSHADHAM

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