11D0930661 CLIA NUMBER - GAMMA ADULT CARE PC

Laboratory Demographics

CLIA Number: 11D0930661

Facility Name: GAMMA ADULT CARE PC

Facility Address:
109 OSIGIAN BLVD STE 200
WARNER ROBINS, GA
ZIP 31088
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Facility Phone Number: 478 953-2212

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1912159062

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name	Field Value
CLIA Number	11D0930661
LAB Type	Physician Office
Facility Name	GAMMA ADULT CARE PC
Street	109 OSIGIAN BLVD STE 200
City	WARNER ROBINS
State	GA
ZIP	31088
Phone	478 953-2212
CertificateType	4
CertificateEffectiveDate	7/16/2023
CertificateExpirationDate	7/15/2025
FacilityType	Waiver

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