11D0960688 CLIA NUMBER - HOLISTIC GYNECOLOGY

Laboratory Demographics

  • CLIA Code: 11D0960688
  • Facility Name: HOLISTIC GYNECOLOGY
  • Facility Address: 2785 LAWRENCEVILLE HIGHWAY SUITE 107
    DECATUR, GA
    ZIP 30033
  • Facility Phone: 770 717-7674
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JUAQITA D. CALLAWAY MD
  • NPI Number: 1700971504
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 11D0960688
LAB Type Physician Office
Facility Name HOLISTIC GYNECOLOGY
Street 2785 LAWRENCEVILLE HIGHWAY SUITE 107
City DECATUR
State GA
ZIP 30033
Phone 770 717-7674
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/24/2025
Certificate Expiration Date 5/23/2027
Facility Type Physician Office
Lab Director JUAQITA D. CALLAWAY MD

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