11D2093874 CLIA NUMBER - KATHLEEN J SMITH , MD, FAAD

Laboratory Demographics

  • CLIA Code: 11D2093874
  • Facility Name: KATHLEEN J SMITH , MD, FAAD
  • Facility Address: 1670 SCOTT BLVD, SUITE 202
    DECATUR, GA
    ZIP 30033
  • Facility Phone: 678 904-4932
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KATHLEEN J. SMITH
  • NPI Number: 1396916219
  • Taxonomy: 207ZD0900X - Pathology

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CLIA Record

Field Name Field Value
CLIA Number 11D2093874
LAB Type Physician Office
Facility Name KATHLEEN J SMITH , MD, FAAD
Street 1670 SCOTT BLVD, SUITE 202
City DECATUR
State GA
ZIP 30033
Phone 678 904-4932
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/9/2025
Certificate Expiration Date 3/8/2027
Facility Type Physician Office
Lab Director KATHLEEN J. SMITH

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