11D2077418 CLIA NUMBER - NORTHSIDE PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 11D2077418
  • Facility Name: NORTHSIDE PRIMARY CARE
  • Facility Address: 2013 LAWRENCEVILLE-SUWANEE RD
    SUWANEE, GA
    ZIP 30024
  • Facility Phone: 678 867-0904
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SYED AAZRUM
  • NPI Number: 1548584972
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2077418
LAB Type Physician Office
Facility Name NORTHSIDE PRIMARY CARE
Street 2013 LAWRENCEVILLE-SUWANEE RD
City SUWANEE
State GA
ZIP 30024
Phone 678 867-0904
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/7/2024
Certificate Expiration Date 5/6/2026
Facility Type Physician Office
Lab Director SYED AAZRUM

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