11D2175576 CLIA NUMBER - NORTHSIDE HOSPITAL RADIATION ONCOLOGY (MIDTOWN)

Laboratory Demographics

  • CLIA Code: 11D2175576
  • Facility Name: NORTHSIDE HOSPITAL RADIATION ONCOLOGY (MIDTOWN)
  • Facility Address: 1110 W PEACHTREE STREET, NW, SUITE 100
    ATLANTA, GA
    ZIP 30309
  • Facility Phone: 770 751-0521
  • Facility Type: Other - O/P DEPT OF HOSPITAL
  • Facility Type: Waiver
  • Lab Director: AHMED ALI
  • NPI Number: 1962060368
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2175576
LAB Type Other - O/P DEPT OF HOSPITAL
Facility Name NORTHSIDE HOSPITAL RADIATION ONCOLOGY (MIDTOWN)
Street 1110 W PEACHTREE STREET, NW, SUITE 100
City ATLANTA
State GA
ZIP 30309
Phone 770 751-0521
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/25/2023
Certificate Expiration Date 11/24/2025
Facility Type Other - O/P DEPT OF HOSPITAL
Lab Director AHMED ALI

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