11D0886668 CLIA NUMBER - 233 CARROLLTON OPCO LLC DBA COUNTRYSIDE POST ACUTE

Laboratory Demographics

  • CLIA Code: 11D0886668
  • Facility Name: 233 CARROLLTON OPCO LLC DBA COUNTRYSIDE POST ACUTE
  • Facility Address: 233 CARROLLTON STREET
    BUCHANAN, GA
    ZIP 30113
  • Facility Phone: 770 646-3861
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: MARK LIPHAM
  • NPI Number: 1902892276
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D0886668
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name 233 CARROLLTON OPCO LLC DBA COUNTRYSIDE POST ACUTE
Street 233 CARROLLTON STREET
City BUCHANAN
State GA
ZIP 30113
Phone 770 646-3861
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/26/2024
Certificate Expiration Date 5/25/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director MARK LIPHAM

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