11D2290053 CLIA NUMBER - PERRY STYLEZ COLLECTION LAB

Laboratory Demographics

CLIA Number: 11D2290053

Facility Name: PERRY STYLEZ COLLECTION LAB

Facility Address:
5737 OLD NATIONAL HIGHWAY
ATLANTA, GA
ZIP 30334
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Facility Phone Number: 833 737-7978

Facility Type: Mobile Laboratory

Certificate Type: Waiver

NPI Number: 1326724113

Taxonomy: 335E00000X - Prosthetic/Orthotic Supplier
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.

CLIA Record

Field Name	Field Value
CLIA Number	11D2290053
LAB Type	Mobile Laboratory
Facility Name	PERRY STYLEZ COLLECTION LAB
Street	5737 OLD NATIONAL HIGHWAY
City	ATLANTA
State	GA
ZIP	30334
Phone	833 737-7978
CertificateType	4
CertificateEffectiveDate	9/20/2023
CertificateExpirationDate	9/19/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024