11D2241714 CLIA NUMBER - PREMIER BEHAVIORAL SERVICES, INC

Laboratory Demographics

  • CLIA Code: 11D2241714
  • Facility Name: PREMIER BEHAVIORAL SERVICES, INC
  • Facility Address: 203 MEDICAL WAY, SUITE B
    RIVERDALE, GA
    ZIP 30274
  • Facility Phone: 910 671-1111
  • Facility Type: Other - SUBSTANCE ABUSE PROG O/P
  • Facility Type: Waiver
  • Lab Director: AUGUSTINE SANTHOSH
  • NPI Number: 1609105592
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 11D2241714
LAB Type Other - SUBSTANCE ABUSE PROG O/P
Facility Name PREMIER BEHAVIORAL SERVICES, INC
Street 203 MEDICAL WAY, SUITE B
City RIVERDALE
State GA
ZIP 30274
Phone 910 671-1111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2023
Certificate Expiration Date 10/31/2025
Facility Type Other - SUBSTANCE ABUSE PROG O/P
Lab Director AUGUSTINE SANTHOSH

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