Certivia Laboratories LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

CERTIVIA LABORATORIES LLC

Practice address

2166 W Park CT Ste F
Stone Mountain, GA 30087-3546

Phone

(770) 696-2522

Fax

(844) 941-1992

NPI assigned

Jul 23, 2019

Last updated

May 16, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tariq Hafeez

Title

General Manager / Owner

Phone

(404) 617-8550

Specialties & licenses 1

Addresses

Other names 1

• Certivia Lab Other name

Medicare fee-for-service enrollment

Enrolled in GA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715817600000",
    "number": "1801449327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920588",
            "city": "PEACHTREE CORNERS",
            "state": "GA",
            "postal_code": "300100588",
            "telephone_number": "770-696-2522",
            "fax_number": "844-941-1992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2166 W PARK CT STE F",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873546",
            "telephone_number": "770-696-2522",
            "fax_number": "844-941-1992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CERTIVIA LABORATORIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-23",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A",
        "authorized_official_last_name": "HAFEEZ",
        "authorized_official_first_name": "TARIQ",
        "authorized_official_title_or_position": "GENERAL MANAGER / OWNER",
        "authorized_official_telephone_number": "404-617-8550"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CERTIVIA LAB",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CERTIVIA LAB",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Certivia Lab",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Aaliyah Casey, CNA
• Maria Joy Cauley, M.A.
• Marc Elie Cayemitte, AGNP-C
• Cedar Communities at Stone Mountain, LLC (Brookside Stone Mountain)
• Centerwell Senior Primary Care Ga PC (CenterWell Senior Primary Care-Stone Mountain)
• Juana Brenda Chairez
• Madhusudan Chandora, M.D.
• Change Agents Counseling & Consulting, LLC
• Joshua Su-Keong Chao, PHARMD
• Cheryl Anne Charles, P.T.

• Clinical Medical Laboratory in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Clinical Medical Laboratory in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.