11D2099931 CLIA NUMBER - SOUTHWEST ATLANTA HOME TRAINING

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Laboratory Demographics

CLIA Number: 11D2099931

Facility Name: SOUTHWEST ATLANTA HOME TRAINING

Facility Address:
3201 ATLANTA INDUSTRIAL PKWY, NW, SUITE 101
ATLANTA, GA
ZIP 30331
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Facility Phone Number: 404 691-1162

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1790171486

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2099931
LAB Type	Federally Qualified Health Center
Facility Name	SOUTHWEST ATLANTA HOME TRAINING
Street	3201 ATLANTA INDUSTRIAL PKWY, NW, SUITE 101
City	ATLANTA
State	GA
ZIP	30331
Phone	404 691-1162
CertificateType	4
CertificateEffectiveDate	8/5/2023
CertificateExpirationDate	8/4/2025
FacilityType	Waiver

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