11D1029442 CLIA NUMBER - AUGUSTA ENT

Laboratory Demographics

  • CLIA Code: 11D1029442
  • Facility Name: AUGUSTA ENT
  • Facility Address: 340 NORTH BELAIR ROAD
    EVANS, GA
    ZIP 30809
  • Facility Phone: 706 868-5676
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWARD PORUBSKY
  • NPI Number: 1679945661
  • Taxonomy: 207Y00000X - Otolaryngology

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CLIA Record

Field Name Field Value
CLIA Number 11D1029442
LAB Type Physician Office
Facility Name AUGUSTA ENT
Street 340 NORTH BELAIR ROAD
City EVANS
State GA
ZIP 30809
Phone 706 868-5676
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/12/2025
Certificate Expiration Date 4/11/2027
Facility Type Physician Office
Lab Director EDWARD PORUBSKY

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