11D2084159 CLIA NUMBER - ATLANTA APC PLASTIC SURGERY

Laboratory Demographics

  • CLIA Code: 11D2084159
  • Facility Name: ATLANTA APC PLASTIC SURGERY
  • Facility Address: 285 BOULEVARD NE SUITE 345B
    ATLANTA, GA
    ZIP 30312
  • Facility Phone: 404 240-2804
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LISA B. BOOTSTAYLOR
  • NPI Number: 1669155396
  • Taxonomy: 208200000X - Plastic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 11D2084159
LAB Type Physician Office
Facility Name ATLANTA APC PLASTIC SURGERY
Street 285 BOULEVARD NE SUITE 345B
City ATLANTA
State GA
ZIP 30312
Phone 404 240-2804
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/19/2024
Certificate Expiration Date 9/18/2026
Facility Type Physician Office
Lab Director LISA B. BOOTSTAYLOR

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