11D0950830 CLIA NUMBER - COMMUNITY MENTAL HEALTH CENTER OF MIDDLE GEORGIA

Laboratory Demographics

CLIA Number: 11D0950830

Facility Name: COMMUNITY MENTAL HEALTH CENTER OF MIDDLE GEORGIA

Facility Address:
2121-A BELLEVUE RD
DUBLIN, GA
ZIP 31021
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Facility Phone Number: 912 272-1190

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1821555913

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D0950830
LAB Type	Other
Facility Name	COMMUNITY MENTAL HEALTH CENTER OF MIDDLE GEORGIA
Street	2121-A BELLEVUE RD
City	DUBLIN
State	GA
ZIP	31021
Phone	912 272-1190
CertificateType	4
CertificateEffectiveDate	9/9/2022
CertificateExpirationDate	9/8/2024
FacilityType	Waiver

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