11D2082892 CLIA NUMBER - NORTHSIDE DECATUR IMAGING

Laboratory Demographics

  • CLIA Code: 11D2082892
  • Facility Name: NORTHSIDE DECATUR IMAGING
  • Facility Address: 2545 LAWRENCEVILLE HWY SUITE 250
    DECATUR, GA
    ZIP 30033
  • Facility Phone: 404 299-2887
  • Facility Type: Other - RADIOLOGY P.E.T. IMAGING
  • Facility Type: Waiver
  • Lab Director: JAMES B. WEINSTEIN
  • NPI Number: 1205481736
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2082892
LAB Type Other - RADIOLOGY P.E.T. IMAGING
Facility Name NORTHSIDE DECATUR IMAGING
Street 2545 LAWRENCEVILLE HWY SUITE 250
City DECATUR
State GA
ZIP 30033
Phone 404 299-2887
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/25/2024
Certificate Expiration Date 8/24/2026
Facility Type Other - RADIOLOGY P.E.T. IMAGING
Lab Director JAMES B. WEINSTEIN

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