11D2156443 CLIA NUMBER - RAVENS NEST FOUNDATION, INC

Laboratory Demographics

  • CLIA Code: 11D2156443
  • Facility Name: RAVENS NEST FOUNDATION, INC
  • Facility Address: 3875 AUSTELL ROAD, SUITE 303
    AUSTELL, GA
    ZIP 30106
  • Facility Phone: 770 819-6825
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. ANGELA SHANNON
  • NPI Number: 1578867982
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2156443
LAB Type Physician Office
Facility Name RAVENS NEST FOUNDATION, INC
Street 3875 AUSTELL ROAD, SUITE 303
City AUSTELL
State GA
ZIP 30106
Phone 770 819-6825
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/18/2024
Certificate Expiration Date 10/17/2026
Facility Type Physician Office
Lab Director DR. ANGELA SHANNON

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