11D2180904 CLIA NUMBER - NORTHSIDE CARDIOVASCULAR INSTITUTE-CANTON

Laboratory Demographics

  • CLIA Code: 11D2180904
  • Facility Name: NORTHSIDE CARDIOVASCULAR INSTITUTE-CANTON
  • Facility Address: 470 NORTHSIDE CHEROKEE BOULEVARD SUITE 480
    CANTON, GA
    ZIP 30115
  • Facility Phone: 404 962-6070
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PRADYUMNA TUMMALA
  • NPI Number: 1265982300
  • Taxonomy: 282N00000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 11D2180904
LAB Type Physician Office
Facility Name NORTHSIDE CARDIOVASCULAR INSTITUTE-CANTON
Street 470 NORTHSIDE CHEROKEE BOULEVARD SUITE 480
City CANTON
State GA
ZIP 30115
Phone 404 962-6070
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/23/2024
Certificate Expiration Date 3/22/2026
Facility Type Physician Office
Lab Director PRADYUMNA TUMMALA

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