11D0645831 CLIA NUMBER - PRUITTHEALTH- MACON, LLC

Laboratory Demographics

  • CLIA Code: 11D0645831
  • Facility Name: PRUITTHEALTH- MACON, LLC
  • Facility Address: 2255 ANTHONY ROAD
    MACON, GA
    ZIP 31204
  • Facility Phone: 478 784-7900
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: ANGELA REDD
  • NPI Number: 1710934237
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D0645831
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PRUITTHEALTH- MACON, LLC
Street 2255 ANTHONY ROAD
City MACON
State GA
ZIP 31204
Phone 478 784-7900
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 ANGELA REDD

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