11D2283561 CLIA NUMBER - NORTH GEORGIA CLINICAL RESEARCH

Laboratory Demographics

  • CLIA Code: 11D2283561
  • Facility Name: NORTH GEORGIA CLINICAL RESEARCH
  • Facility Address: 1196 BUCKHEAD CROSSING, SUITE D
    WOODSTOCK, GA
    ZIP 30189
  • Facility Phone: 678 494-4450
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: BRAM D. WIESKOPF
  • NPI Number: 1619996907
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2283561
LAB Type Practitioner Other
Facility Name NORTH GEORGIA CLINICAL RESEARCH
Street 1196 BUCKHEAD CROSSING, SUITE D
City WOODSTOCK
State GA
ZIP 30189
Phone 678 494-4450
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/9/2025
Certificate Expiration Date 6/8/2027
Facility Type Practitioner Other
Lab Director BRAM D. WIESKOPF

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