11D2136124 CLIA NUMBER - TRI-STATE TREATMENT

Laboratory Demographics

  • CLIA Code: 11D2136124
  • Facility Name: TRI-STATE TREATMENT
  • Facility Address: 1236 HIGHWAY 299
    WILDWOOD, GA
    ZIP 30757
  • Facility Phone: 423 428-0045
  • Facility Type: Other - OPLATE TREATMENT PROGRAM
  • Facility Type: Waiver
  • Lab Director: MELISSA M. HANCOCK
  • NPI Number: 1780036210
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D2136124
LAB Type Other - OPLATE TREATMENT PROGRAM
Facility Name TRI-STATE TREATMENT
Street 1236 HIGHWAY 299
City WILDWOOD
State GA
ZIP 30757
Phone 423 428-0045
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/5/2025
Certificate Expiration Date 9/4/2027
Facility Type Other - OPLATE TREATMENT PROGRAM
Lab Director MELISSA M. HANCOCK

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This page was last updated on: 9/29/2025