11D0255897 CLIA NUMBER - MEADOWBROOK NURSING HOME

Laboratory Demographics

  • CLIA Code: 11D0255897
  • Facility Name: MEADOWBROOK NURSING HOME
  • Facility Address: 4608 LAWRENCEVILLE HWY
    TUCKER, GA
    ZIP 30084
  • Facility Phone: 770 491-9444
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JOHN L. CLARK
  • NPI Number: 1508038753
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D0255897
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MEADOWBROOK NURSING HOME
Street 4608 LAWRENCEVILLE HWY
City TUCKER
State GA
ZIP 30084
Phone 770 491-9444
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director JOHN L. CLARK

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