11D2156378 CLIA NUMBER - TRI COUNTY INTERNAL MEDICINE, PC

Laboratory Demographics

  • CLIA Code: 11D2156378
  • Facility Name: TRI COUNTY INTERNAL MEDICINE, PC
  • Facility Address: 4465 NELSON BROGDON BOULEVARD
    BUFORD, GA
    ZIP 30518
  • Facility Phone: 770 945-1990
  • Facility Type: Independent
  • Facility Type: Microscopy
  • Lab Director: ROBERT T. DAMBACH
  • NPI Number: 1528097318
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2156378
LAB Type Independent
Facility Name TRI COUNTY INTERNAL MEDICINE, PC
Street 4465 NELSON BROGDON BOULEVARD
City BUFORD
State GA
ZIP 30518
Phone 770 945-1990
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/17/2024
Certificate Expiration Date 10/16/2026
Facility Type Independent
Lab Director ROBERT T. DAMBACH

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