11D0976438 CLIA NUMBER - NORTHSIDE HOSPITAL, INC - GCS/MILLEDGEVILLE

Laboratory Demographics

CLIA Number: 11D0976438

Facility Name: NORTHSIDE HOSPITAL, INC - GCS/MILLEDGEVILLE

Facility Address:
624 MARTIN LUTHER KING JR DRIVE
MILLEDGEVILLE, GA
ZIP 31061
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Facility Phone Number: 478 453-1806

Facility Type: Physician Office

Certificate Type: Accreditation

NPI Number: 1316124324

Taxonomy: 335E00000X - Prosthetic/Orthotic Supplier
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.

CLIA Record

Field Name	Field Value
CLIA Number	11D0976438
LAB Type	Physician Office
Facility Name	NORTHSIDE HOSPITAL, INC - GCS/MILLEDGEVILLE
Street	624 MARTIN LUTHER KING JR DRIVE
City	MILLEDGEVILLE
State	GA
ZIP	31061
Phone	478 453-1806
CertificateType	1
CertificateEffectiveDate	12/18/2023
CertificateExpirationDate	12/17/2025
FacilityType	Accreditation

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