11D0725439 CLIA NUMBER - PRUITTHEALTH- AUGUSTA, LLC

Laboratory Demographics

  • CLIA Code: 11D0725439
  • Facility Name: PRUITTHEALTH- AUGUSTA, LLC
  • Facility Address: 2541 MILLEDGEVILLE ROAD
    AUGUSTA, GA
    ZIP 30904
  • Facility Phone: 706 738-2581
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: MARY ISHMAEL
  • NPI Number: 1295908846
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D0725439
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PRUITTHEALTH- AUGUSTA, LLC
Street 2541 MILLEDGEVILLE ROAD
City AUGUSTA
State GA
ZIP 30904
Phone 706 738-2581
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 MARY ISHMAEL

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