11D1048896 CLIA NUMBER - GEORGIA GYNECOLOGY PC

Laboratory Demographics

  • CLIA Code: 11D1048896
  • Facility Name: GEORGIA GYNECOLOGY PC
  • Facility Address: 1690 STONE VILLAGE LANE SUITE 401
    KENNESAW, GA
    ZIP 30152
  • Facility Phone: 770 427-2533
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MOJGAN KHATAMI
  • NPI Number: 1538354071
  • Taxonomy: 207VG0400X - Obstetrics & Gynecology

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D1048896
LAB Type Physician Office
Facility Name GEORGIA GYNECOLOGY PC
Street 1690 STONE VILLAGE LANE SUITE 401
City KENNESAW
State GA
ZIP 30152
Phone 770 427-2533
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 12/14/2023
Certificate Expiration Date 12/13/2025
Facility Type Physician Office
Lab Director MOJGAN KHATAMI

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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