11D1051448 CLIA NUMBER - SOUTHERN CRESCENT NEUROLOGICAL CLINIC

Laboratory Demographics

CLIA Number: 11D1051448

Facility Name: SOUTHERN CRESCENT NEUROLOGICAL CLINIC

Facility Address:
1250 HIGHWAY 54 W, SUITE 102
FAYETTEVILLE, GA
ZIP 30214
Get Directions

Facility Phone Number: 770 719-2965

Facility Type: Physician Office

Certificate Type: Accreditation

NPI Number: 1013052182

Taxonomy: 2084N0400X - Psychiatry & Neurology
A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.

CLIA Record

Field Name	Field Value
CLIA Number	11D1051448
LAB Type	Physician Office
Facility Name	SOUTHERN CRESCENT NEUROLOGICAL CLINIC
Street	1250 HIGHWAY 54 W, SUITE 102
City	FAYETTEVILLE
State	GA
ZIP	30214
Phone	770 719-2965
CertificateType	1
CertificateEffectiveDate	12/11/2022
CertificateExpirationDate	12/10/2024
FacilityType	Accreditation

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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