11D2169009 CLIA NUMBER - ENDOHEALTH

Laboratory Demographics

  • CLIA Code: 11D2169009
  • Facility Name: ENDOHEALTH
  • Facility Address: 135 VANN STREET
    MARIETTA, GA
    ZIP 30060
  • Facility Phone: 678 829-6030
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GAYATHRI K. DEVINENI
  • NPI Number: 1710428305
  • Taxonomy: 2080P0205X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D2169009
LAB Type Physician Office
Facility Name ENDOHEALTH
Street 135 VANN STREET
City MARIETTA
State GA
ZIP 30060
Phone 678 829-6030
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/15/2025
Certificate Expiration Date 7/14/2027
Facility Type Physician Office
Lab Director GAYATHRI K. DEVINENI

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