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11D2264328 CLIA NUMBER - CHILDREN'S HEALTHCARE OF ATLANTA NEPHROLOGY AT FAYETTE

Laboratory Demographics

CLIA Number: 11D2264328

Facility Name: CHILDREN'S HEALTHCARE OF ATLANTA NEPHROLOGY AT FAYETTE

Facility Address:
1250 HIGHWAY 54 SUITE 200
FAYETTEVILLE, GA
ZIP 30214
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Facility Phone Number: 404 785-5437

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Waiver
NPI Number: 1144374604

Taxonomy: 261QM0855X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.

CLIA Record

Field Name Field Value
CLIA Number 11D2264328
LAB Type Ancillary Testing Site in Health Care Center
Facility Name CHILDREN'S HEALTHCARE OF ATLANTA NEPHROLOGY AT FAYETTE
Street 1250 HIGHWAY 54 SUITE 200
City FAYETTEVILLE
State GA
ZIP 30214
Phone 404 785-5437
CertificateType 4
CertificateEffectiveDate 7/13/2022
CertificateExpirationDate 7/12/2024
FacilityType Waiver

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