11D2290794 CLIA NUMBER - EVERSIDE HEALTH DEKALB

Laboratory Demographics

  • CLIA Code: 11D2290794
  • Facility Name: EVERSIDE HEALTH DEKALB
  • Facility Address: 465 WINN WAY, SUITE 215
    DECATUR, GA
    ZIP 30030
  • Facility Phone: 404 645-7166
  • Facility Type: Other - CHRONIC MGT
  • Facility Type: Waiver
  • Lab Director: MWICHE WILLIAMS
  • NPI Number: 1962194688
  • Taxonomy: 2083P0500X - Preventive Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2290794
LAB Type Other - CHRONIC MGT
Facility Name EVERSIDE HEALTH DEKALB
Street 465 WINN WAY, SUITE 215
City DECATUR
State GA
ZIP 30030
Phone 404 645-7166
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 Other - CHRONIC MGT
Lab Director MWICHE WILLIAMS

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