11D2237361 CLIA NUMBER - CARON OF GEORGIA, LLC

Laboratory Demographics

CLIA Number: 11D2237361

Facility Name: CARON OF GEORGIA, LLC

Facility Address:
1200 ASHWOOD PARKWAY SUITE 125
ATLANTA, GA
ZIP 30338
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Facility Phone Number: 678 543-5710

Facility Type: Other - OUTPATEINT ADDICTION

Certificate Type: Waiver

NPI Number: 1386019008

Taxonomy: 261QR0800X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2237361
LAB Type	Other - OUTPATEINT ADDICTION
Facility Name	CARON OF GEORGIA, LLC
Street	1200 ASHWOOD PARKWAY SUITE 125
City	ATLANTA
State	GA
ZIP	30338
Phone	678 543-5710
CertificateType	4
CertificateEffectiveDate	9/24/2023
CertificateExpirationDate	9/23/2025
FacilityType	Waiver

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