11D2119762 CLIA NUMBER - PLASTIC, HEAD AND NECK SURGERY INSTITUTE, LLC

Laboratory Demographics

  • CLIA Code: 11D2119762
  • Facility Name: PLASTIC, HEAD AND NECK SURGERY INSTITUTE, LLC
  • Facility Address: 5730 GLENRIDGE DRIVE, SUITE T150
    ATLANTA, GA
    ZIP 30328
  • Facility Phone: 404 256-5428
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: PRADEEP SINHA
  • NPI Number: 1295288751
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2119762
LAB Type Ambulatory Surgery Center
Facility Name PLASTIC, HEAD AND NECK SURGERY INSTITUTE, LLC
Street 5730 GLENRIDGE DRIVE, SUITE T150
City ATLANTA
State GA
ZIP 30328
Phone 404 256-5428
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/4/2024
Certificate Expiration Date 10/3/2026
Facility Type Ambulatory Surgery Center
Lab Director PRADEEP SINHA

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