11D2214764 CLIA NUMBER - MIND AND BODY WELLNESS CENTER, PC

Laboratory Demographics

CLIA Number: 11D2214764

Facility Name: MIND AND BODY WELLNESS CENTER, PC

Facility Address:
10475 MEDLOCK BRIDGE ROAD, BLDG 800, SUITE 820
JOHNS CREEK, GA
ZIP 30097
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Facility Phone Number: 404 800-5181

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1053919225

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2214764
LAB Type	Physician Office
Facility Name	MIND AND BODY WELLNESS CENTER, PC
Street	10475 MEDLOCK BRIDGE ROAD, BLDG 800, SUITE 820
City	JOHNS CREEK
State	GA
ZIP	30097
Phone	404 800-5181
CertificateType	4
CertificateEffectiveDate	2/25/2023
CertificateExpirationDate	2/24/2025
FacilityType	Waiver

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