11D2203326 CLIA NUMBER - CHASTAIN MD

Laboratory Demographics

  • CLIA Code: 11D2203326
  • Facility Name: CHASTAIN MD
  • Facility Address: 115 LAUREL DRIVE
    ATLANTA, GA
    ZIP 30342
  • Facility Phone: 404 953-7727
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: WALKITRIA SMITH
  • NPI Number: 1902266638
  • Taxonomy: 1223G0001X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 11D2203326
LAB Type Practitioner Other
Facility Name CHASTAIN MD
Street 115 LAUREL DRIVE
City ATLANTA
State GA
ZIP 30342
Phone 404 953-7727
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2024
Certificate Expiration Date 12/2/2026
Facility Type Practitioner Other
Lab Director WALKITRIA SMITH

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