11D2290794 CLIA NUMBER - EVERSIDE HEALTH DEKALB

Laboratory Demographics

CLIA Number: 11D2290794

Facility Name: EVERSIDE HEALTH DEKALB

Facility Address:
465 WINN WAY, SUITE 215
DECATUR, GA
ZIP 30030
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Facility Phone Number: 404 645-7166

Facility Type: Other - CHRONIC MGT

Certificate Type: Waiver

NPI Number: 1962194688

Taxonomy: 2083P0500X - Preventive Medicine
A preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the population from occupational and environmental conditions.

CLIA Record

Field Name	Field Value
CLIA Number	11D2290794
LAB Type	Other - CHRONIC MGT
Facility Name	EVERSIDE HEALTH DEKALB
Street	465 WINN WAY, SUITE 215
City	DECATUR
State	GA
ZIP	30030
Phone	404 645-7166
CertificateType	4
CertificateEffectiveDate	10/2/2023
CertificateExpirationDate	10/1/2025
FacilityType	Waiver

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