11D2273252 CLIA NUMBER - WHOLENESS WITHIN LLC

Laboratory Demographics

  • CLIA Code: 11D2273252
  • Facility Name: WHOLENESS WITHIN LLC
  • Facility Address: 4292 MEMORIAL DRIVE, BLDG C
    DECATUR, GA
    ZIP 30032
  • Facility Phone: 404 597-3613
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: ROY HARGROVE
  • NPI Number: 1255042982
  • Taxonomy: 103TA0400X - Psychologist

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2273252
LAB Type Comp. Outpatient Rehab Facility
Facility Name WHOLENESS WITHIN LLC
Street 4292 MEMORIAL DRIVE, BLDG C
City DECATUR
State GA
ZIP 30032
Phone 404 597-3613
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/9/2024
Certificate Expiration Date 12/8/2026
Facility Type Comp. Outpatient Rehab Facility
Lab Director ROY HARGROVE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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