11D0646199 CLIA NUMBER - WEST CENTRAL GEORGIA REGIONAL HOSPITAL

Laboratory Demographics

CLIA Number: 11D0646199

Facility Name: WEST CENTRAL GEORGIA REGIONAL HOSPITAL

Facility Address:
3000 SCHATULGA RD ATTN DR BROOKE DEVLIN
COLUMBUS, GA
ZIP 31907
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Facility Phone Number: 706 568-5107

Facility Type: Hospital

Certificate Type: Waiver

NPI Number: 1548312358

Taxonomy: 261QM0855X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.

CLIA Record

Field Name	Field Value
CLIA Number	11D0646199
LAB Type	Hospital
Facility Name	WEST CENTRAL GEORGIA REGIONAL HOSPITAL
Street	3000 SCHATULGA RD ATTN DR BROOKE DEVLIN
City	COLUMBUS
State	GA
ZIP	31907
Phone	706 568-5107
CertificateType	4
CertificateEffectiveDate	9/3/2023
CertificateExpirationDate	9/2/2025
FacilityType	Waiver

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