11D2139910 CLIA NUMBER - NORTHSIDE-CARDIOVASCULAR GROUP (BUFORD)

Laboratory Demographics

  • CLIA Code: 11D2139910
  • Facility Name: NORTHSIDE-CARDIOVASCULAR GROUP (BUFORD)
  • Facility Address: 2800 BUFORD DRIVE, SUITE 320
    BUFORD, GA
    ZIP 30519
  • Facility Phone: 770 962-0399
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PHILLIP A. ROMM
  • NPI Number: 1821612938
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2139910
LAB Type Physician Office
Facility Name NORTHSIDE-CARDIOVASCULAR GROUP (BUFORD)
Street 2800 BUFORD DRIVE, SUITE 320
City BUFORD
State GA
ZIP 30519
Phone 770 962-0399
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/13/2023
Certificate Expiration Date 11/12/2025
Facility Type Physician Office
Lab Director PHILLIP A. ROMM

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