11D2138442 CLIA NUMBER - ANGELIC CLINICAL SERVICES, LLC

Laboratory Demographics

  • CLIA Code: 11D2138442
  • Facility Name: ANGELIC CLINICAL SERVICES, LLC
  • Facility Address: 305 COOPER ROAD, SUITE 100
    LOGANVILLE, GA
    ZIP 30052
  • Facility Phone: 770 568-2777
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JOY S. WILSON
  • NPI Number: 1497299440
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2138442
LAB Type Practitioner Other
Facility Name ANGELIC CLINICAL SERVICES, LLC
Street 305 COOPER ROAD, SUITE 100
City LOGANVILLE
State GA
ZIP 30052
Phone 770 568-2777
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/16/2024
Certificate Expiration Date 10/15/2026
Facility Type Practitioner Other
Lab Director JOY S. WILSON

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