11D2084364 CLIA NUMBER - CONCENTRA - AUSTELL

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Laboratory Demographics

CLIA Number: 11D2084364

Facility Name: CONCENTRA - AUSTELL

Facility Address:
7750 THE BLUFFS SUITE 100
AUSTELL, GA
ZIP 30168
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Facility Phone Number: 404 691-4999

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1508332255

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2084364
LAB Type	Physician Office
Facility Name	CONCENTRA - AUSTELL
Street	7750 THE BLUFFS SUITE 100
City	AUSTELL
State	GA
ZIP	30168
Phone	404 691-4999
CertificateType	4
CertificateEffectiveDate	9/23/2022
CertificateExpirationDate	9/22/2024
FacilityType	Waiver

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