11D2136122 CLIA NUMBER - NORTHSIDE - PRIMARY CARE OF MILTON

Laboratory Demographics

  • CLIA Code: 11D2136122
  • Facility Name: NORTHSIDE - PRIMARY CARE OF MILTON
  • Facility Address: 980 BIRMINGHAM ROAD, SUITE 304
    MILTON, GA
    ZIP 30004
  • Facility Phone: 470 639-6340
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SIDHARTH SHARMA
  • NPI Number: 1265664791
  • Taxonomy: 171100000X - Acupuncturist

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CLIA Record

Field Name Field Value
CLIA Number 11D2136122
LAB Type Physician Office
Facility Name NORTHSIDE - PRIMARY CARE OF MILTON
Street 980 BIRMINGHAM ROAD, SUITE 304
City MILTON
State GA
ZIP 30004
Phone 470 639-6340
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/5/2025
Certificate Expiration Date 9/4/2027
Facility Type Physician Office
Lab Director SIDHARTH SHARMA

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