11D2131205 CLIA NUMBER - PROACTIVE PHYSICIANS OF MARIETTA, PC

Laboratory Demographics

  • CLIA Code: 11D2131205
  • Facility Name: PROACTIVE PHYSICIANS OF MARIETTA, PC
  • Facility Address: 790 CHURCH STREET, SUITE 220
    MARIETTA, GA
    ZIP 30060
  • Facility Phone: 678 753-9300
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: R SCOTT MILLS
  • NPI Number: 1003356361
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2131205
LAB Type Physician Office
Facility Name PROACTIVE PHYSICIANS OF MARIETTA, PC
Street 790 CHURCH STREET, SUITE 220
City MARIETTA
State GA
ZIP 30060
Phone 678 753-9300
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/24/2025
Certificate Expiration Date 5/23/2027
Facility Type Physician Office
Lab Director R SCOTT MILLS

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