11D1040752 CLIA NUMBER - PSYCH ATLANTA, PC

Laboratory Demographics

  • CLIA Code: 11D1040752
  • Facility Name: PSYCH ATLANTA, PC
  • Facility Address: 1012 COGGINS PLACE
    MARIETTA, GA
    ZIP 30060
  • Facility Phone: 770 422-2846
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL D. BANOV
  • NPI Number: 1184756090
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 11D1040752
LAB Type Physician Office
Facility Name PSYCH ATLANTA, PC
Street 1012 COGGINS PLACE
City MARIETTA
State GA
ZIP 30060
Phone 770 422-2846
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/17/2025
Certificate Expiration Date 5/16/2027
Facility Type Physician Office
Lab Director MICHAEL D. BANOV

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