11D2195357 CLIA NUMBER - MONTE NIDO GEORGIA, LLC BA CLEMENTINE ATLANTA

Laboratory Demographics

CLIA Code: 11D2195357
Facility Name: MONTE NIDO GEORGIA, LLC BA CLEMENTINE ATLANTA
Facility Address: 126 JOHNSON FERRY ROAD, NE
SANDY SPRINGS, GA
ZIP 30328
Facility Phone: 404 760-8421
Facility Type: Other - RES MENTAL HLTH FAC
Facility Type: Waiver
Lab Director: MOLLY M. PERLMAN
NPI Number: 1073141271
Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	11D2195357
LAB Type	Other - RES MENTAL HLTH FAC
Facility Name	MONTE NIDO GEORGIA, LLC BA CLEMENTINE ATLANTA
Street	126 JOHNSON FERRY ROAD, NE
City	SANDY SPRINGS
State	GA
ZIP	30328
Phone	404 760-8421
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	10/8/2024
Certificate Expiration Date	10/7/2026
Facility Type	Other - RES MENTAL HLTH FAC
Lab Director	MOLLY M. PERLMAN

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