11D2069280 CLIA NUMBER - GEORGIA PLASTIC AND RECONSTRUCTIVE SURGERY, PC

Laboratory Demographics

  • CLIA Code: 11D2069280
  • Facility Name: GEORGIA PLASTIC AND RECONSTRUCTIVE SURGERY, PC
  • Facility Address: 2285 ASQUITH AVENUE, SUITE 200
    MARIETTA, GA
    ZIP 30008
  • Facility Phone: 770 485-1554
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STANLEY A. OKORO
  • NPI Number: 1447580790
  • Taxonomy: 208200000X - Plastic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 11D2069280
LAB Type Physician Office
Facility Name GEORGIA PLASTIC AND RECONSTRUCTIVE SURGERY, PC
Street 2285 ASQUITH AVENUE, SUITE 200
City MARIETTA
State GA
ZIP 30008
Phone 770 485-1554
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/21/2023
Certificate Expiration Date 11/20/2025
Facility Type Physician Office
Lab Director STANLEY A. OKORO

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