11D2291563 CLIA NUMBER - MEADOWS OUTPATIENT CENTER GEORGIA LLC

Laboratory Demographics

CLIA Number: 11D2291563

Facility Name: MEADOWS OUTPATIENT CENTER GEORGIA LLC

Facility Address:
5607 GLENRIDGE DRIVE, SUITE 100
ATLANTA, GA
ZIP 30342
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Facility Phone Number: 404 500-5714

Facility Type: Other - OUTPATIENT TREATMENT CENT

Certificate Type: Waiver

NPI Number: 1336827724

Taxonomy: 261QM0850X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.

CLIA Record

Field Name	Field Value
CLIA Number	11D2291563
LAB Type	Other - OUTPATIENT TREATMENT CENT
Facility Name	MEADOWS OUTPATIENT CENTER GEORGIA LLC
Street	5607 GLENRIDGE DRIVE, SUITE 100
City	ATLANTA
State	GA
ZIP	30342
Phone	404 500-5714
CertificateType	4
CertificateEffectiveDate	10/12/2023
CertificateExpirationDate	10/11/2025
FacilityType	Waiver

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