11D1032456 CLIA NUMBER - AUGUSTA STATE MEDICAL PRISON

Laboratory Demographics

  • CLIA Code: 11D1032456
  • Facility Name: AUGUSTA STATE MEDICAL PRISON
  • Facility Address: 3001 GORDON HIGHWAY
    GROVETOWN, GA
    ZIP 30813
  • Facility Phone: 678 470-3977
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: LEE LAROWE
  • NPI Number: 1902397151
  • Taxonomy: 3336I0012X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D1032456
LAB Type Prison
Facility Name AUGUSTA STATE MEDICAL PRISON
Street 3001 GORDON HIGHWAY
City GROVETOWN
State GA
ZIP 30813
Phone 678 470-3977
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/1/2024
Certificate Expiration Date 6/30/2026
Facility Type Prison
Lab Director LEE LAROWE

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