11D2258888 CLIA NUMBER - NIGHTFALL MEDICAL

Laboratory Demographics

  • CLIA Code: 11D2258888
  • Facility Name: NIGHTFALL MEDICAL
  • Facility Address: 322 NORTH 3RD AVENUE
    CHATSWORTH, GA
    ZIP 30705
  • Facility Phone: 706 264-3451
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROBERT T. COOK
  • NPI Number: 1285386193
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2258888
LAB Type Physician Office
Facility Name NIGHTFALL MEDICAL
Street 322 NORTH 3RD AVENUE
City CHATSWORTH
State GA
ZIP 30705
Phone 706 264-3451
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2024
Certificate Expiration Date 4/27/2026
Facility Type Physician Office
Lab Director ROBERT T. COOK

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