11D2102922 CLIA NUMBER - BROAD STREET REDDY MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 11D2102922
  • Facility Name: BROAD STREET REDDY MEDICAL GROUP
  • Facility Address: 855 WEST BROAD STREET
    ATHENS, GA
    ZIP 30601
  • Facility Phone: 706 621-7575
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MALINI K. REDDY
  • NPI Number: 1649762121
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2102922
LAB Type Physician Office
Facility Name BROAD STREET REDDY MEDICAL GROUP
Street 855 WEST BROAD STREET
City ATHENS
State GA
ZIP 30601
Phone 706 621-7575
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2025
Certificate Expiration Date 9/30/2027
Facility Type Physician Office
Lab Director MALINI K. REDDY

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