11D0265574 CLIA NUMBER - PRUITTHEALTH-HOLLY HILL, LLC

Laboratory Demographics

  • CLIA Code: 11D0265574
  • Facility Name: PRUITTHEALTH-HOLLY HILL, LLC
  • Facility Address: 413 PENDLETON PLACE
    VALDOSTA, GA
    ZIP 31602
  • Facility Phone: 229 244-6968
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: CHERYL COLEMAN
  • NPI Number: 1659310662
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D0265574
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PRUITTHEALTH-HOLLY HILL, LLC
Street 413 PENDLETON PLACE
City VALDOSTA
State GA
ZIP 31602
Phone 229 244-6968
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director CHERYL COLEMAN

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