11D0938739 CLIA NUMBER - BRANDON WILDE LLC DBA THE PAVILION AT BRANDON WILDE

Laboratory Demographics

  • CLIA Code: 11D0938739
  • Facility Name: BRANDON WILDE LLC DBA THE PAVILION AT BRANDON WILDE
  • Facility Address: 4275 OWENS ROAD
    EVANS, GA
    ZIP 30809
  • Facility Phone: 706 868-9800
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: FREDERICK A. MERRILL III
  • NPI Number: 1821580440
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D0938739
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name BRANDON WILDE LLC DBA THE PAVILION AT BRANDON WILDE
Street 4275 OWENS ROAD
City EVANS
State GA
ZIP 30809
Phone 706 868-9800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/14/2024
Certificate Expiration Date 1/13/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director FREDERICK A. MERRILL III

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