11D0934446 CLIA NUMBER - EAST ALBANY PEDIATRIC & ADOLESCENCE CENTER

Laboratory Demographics

CLIA Number: 11D0934446

Facility Name: EAST ALBANY PEDIATRIC & ADOLESCENCE CENTER

Facility Address:
1712 C EAST BROAD AVENUE
ALBANY, GA
ZIP 31705
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Facility Phone Number: 229 639-3103

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1346265550

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D0934446
LAB Type	Federally Qualified Health Center
Facility Name	EAST ALBANY PEDIATRIC & ADOLESCENCE CENTER
Street	1712 C EAST BROAD AVENUE
City	ALBANY
State	GA
ZIP	31705
Phone	229 639-3103
CertificateType	4
CertificateEffectiveDate	10/7/2023
CertificateExpirationDate	10/6/2025
FacilityType	Waiver

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