11D0705016 CLIA NUMBER - JOSEPH M STILL BURN CENTER INCORPORATE

Laboratory Demographics

CLIA Number: 11D0705016

Facility Name: JOSEPH M STILL BURN CENTER INCORPORATE

Facility Address:
3675 J DEWEY GRAY CIR
AUGUSTA, GA
ZIP 30909
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Facility Phone Number: 706 863-9595

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1891468518

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	11D0705016
LAB Type	Physician Office
Facility Name	JOSEPH M STILL BURN CENTER INCORPORATE
Street	3675 J DEWEY GRAY CIR
City	AUGUSTA
State	GA
ZIP	30909
Phone	706 863-9595
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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