11D2031662 CLIA NUMBER - KATIE CLINIC, INC

Laboratory Demographics

  • CLIA Code: 11D2031662
  • Facility Name: KATIE CLINIC, INC
  • Facility Address: 4585 AUSTELL ROAD
    AUSTELL, GA
    ZIP 30106
  • Facility Phone: 770 948-9338
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANTHONY U. EKWENCHI
  • NPI Number: 1447442827
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 11D2031662
LAB Type Physician Office
Facility Name KATIE CLINIC, INC
Street 4585 AUSTELL ROAD
City AUSTELL
State GA
ZIP 30106
Phone 770 948-9338
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/25/2023
Certificate Expiration Date 10/24/2025
Facility Type Physician Office
Lab Director ANTHONY U. EKWENCHI

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