11D2193344 CLIA NUMBER - NORTH ATLANTA MENTAL WELLNESS

Laboratory Demographics

  • CLIA Code: 11D2193344
  • Facility Name: NORTH ATLANTA MENTAL WELLNESS
  • Facility Address: 1742-150C MOUNT VERNON ROAD
    ATLANTA, GA
    ZIP 30338
  • Facility Phone: 631 512-1567
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PAUL PANCHAJANYA
  • NPI Number: 1780296533
  • Taxonomy: 261QM0850X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2193344
LAB Type Physician Office
Facility Name NORTH ATLANTA MENTAL WELLNESS
Street 1742-150C MOUNT VERNON ROAD
City ATLANTA
State GA
ZIP 30338
Phone 631 512-1567
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/21/2024
Certificate Expiration Date 9/20/2026
Facility Type Physician Office
Lab Director PAUL PANCHAJANYA

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