11D2109168 CLIA NUMBER - BUCKHEAD FACIAL PLASTIC SURGERY

Laboratory Demographics

CLIA Number: 11D2109168

Facility Name: BUCKHEAD FACIAL PLASTIC SURGERY

Facility Address:
1218 WEST PACES FERRY RD NE SUITE #108
ATLANTA, GA
ZIP 30327
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Facility Phone Number: 404 233-3937

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1588797435

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	11D2109168
LAB Type	Ambulatory Surgery Center
Facility Name	BUCKHEAD FACIAL PLASTIC SURGERY
Street	1218 WEST PACES FERRY RD NE SUITE #108
City	ATLANTA
State	GA
ZIP	30327
Phone	404 233-3937
CertificateType	4
CertificateEffectiveDate	2/19/2024
CertificateExpirationDate	2/18/2026
FacilityType	Waiver

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