11D2092651 CLIA NUMBER - ATLANTA INTERNAL MEDICINE PC

Laboratory Demographics

  • CLIA Code: 11D2092651
  • Facility Name: ATLANTA INTERNAL MEDICINE PC
  • Facility Address: 3775 VENTURE DRIVE BUILDING H SUITE 101
    DULUTH, GA
    ZIP 30096
  • Facility Phone: 000 770-8585
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KIM M. JO
  • NPI Number: 1639567472
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2092651
LAB Type Physician Office
Facility Name ATLANTA INTERNAL MEDICINE PC
Street 3775 VENTURE DRIVE BUILDING H SUITE 101
City DULUTH
State GA
ZIP 30096
Phone 000 770-8585
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/10/2025
Certificate Expiration Date 3/9/2027
Facility Type Physician Office
Lab Director KIM M. JO

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