11D2306223 CLIA NUMBER - A BEAUTIFUL MIND PSYCHIATRY PLLC

Laboratory Demographics

  • CLIA Code: 11D2306223
  • Facility Name: A BEAUTIFUL MIND PSYCHIATRY PLLC
  • Facility Address: 948 HIGHWAY 138
    RIVERDALE, GA
    ZIP 30296
  • Facility Phone: 706 449-2884
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHARMAINE WILSON
  • NPI Number: 1861266397
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 11D2306223
LAB Type Physician Office
Facility Name A BEAUTIFUL MIND PSYCHIATRY PLLC
Street 948 HIGHWAY 138
City RIVERDALE
State GA
ZIP 30296
Phone 706 449-2884
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/13/2024
Certificate Expiration Date 6/12/2026
Facility Type Physician Office
Lab Director CHARMAINE WILSON

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