11D0257390 CLIA NUMBER - WELLSTAR SYLVAN GROVE HOSPITAL

Laboratory Demographics

CLIA Number: 11D0257390

Facility Name: WELLSTAR SYLVAN GROVE HOSPITAL

Facility Address:
1050 MCDONOUGH ROAD, ATTN LABORATORY
JACKSON, GA
ZIP 30233
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Facility Phone Number: 770 775-7861

Facility Type: Hospital

Certificate Type: Certificate of Compliance

NPI Number: 1386664779

Taxonomy: 282NC0060X - General Acute Care Hospital

CLIA Record

Field Name	Field Value
CLIA Number	11D0257390
LAB Type	Hospital
Facility Name	WELLSTAR SYLVAN GROVE HOSPITAL
Street	1050 MCDONOUGH ROAD, ATTN LABORATORY
City	JACKSON
State	GA
ZIP	30233
Phone	770 775-7861
CertificateType	2
CertificateEffectiveDate	3/22/2023
CertificateExpirationDate	3/21/2025
FacilityType	Compliance

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