11D0264199 CLIA NUMBER - PRUITTHEALTH - EASTSIDE, LLC

Laboratory Demographics

  • CLIA Code: 11D0264199
  • Facility Name: PRUITTHEALTH - EASTSIDE, LLC
  • Facility Address: 2795 FINNEY CIRCLE
    MACON, GA
    ZIP 31217
  • Facility Phone: 478 742-1117
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: ASHLEY GOOLSBY
  • NPI Number: 1013321884
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D0264199
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PRUITTHEALTH - EASTSIDE, LLC
Street 2795 FINNEY CIRCLE
City MACON
State GA
ZIP 31217
Phone 478 742-1117
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/2/2025
Certificate Expiration Date 7/1/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director ASHLEY GOOLSBY

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