11D2172929 CLIA NUMBER - NORTHSIDE CARDIOVASCULAR INSTITUTE- GAINESVILLE

Laboratory Demographics

  • CLIA Code: 11D2172929
  • Facility Name: NORTHSIDE CARDIOVASCULAR INSTITUTE- GAINESVILLE
  • Facility Address: 1276 JESSE JEWEL PARKWAY
    GAINESVILLE, GA
    ZIP 30501
  • Facility Phone: 404 962-6000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PRADYUMNA TUMMALA
  • NPI Number: 1417391194
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2172929
LAB Type Physician Office
Facility Name NORTHSIDE CARDIOVASCULAR INSTITUTE- GAINESVILLE
Street 1276 JESSE JEWEL PARKWAY
City GAINESVILLE
State GA
ZIP 30501
Phone 404 962-6000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/2/2025
Certificate Expiration Date 10/1/2027
Facility Type Physician Office
Lab Director PRADYUMNA TUMMALA

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