11D2107142 CLIA NUMBER - GEORGIA RETINA, PC

Laboratory Demographics

CLIA Number: 11D2107142

Facility Name: GEORGIA RETINA, PC

Facility Address:
833 CAMPBELL HILL STREET, SUITE 300 ATTN LESLIE MARCUS
MARIETTA, GA
ZIP 30060
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Facility Phone Number: 770 218-1888

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1023027430

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	11D2107142
LAB Type	Physician Office
Facility Name	GEORGIA RETINA, PC
Street	833 CAMPBELL HILL STREET, SUITE 300 ATTN LESLIE MARCUS
City	MARIETTA
State	GA
ZIP	30060
Phone	770 218-1888
CertificateType	4
CertificateEffectiveDate	1/7/2024
CertificateExpirationDate	1/6/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024