11D1040215 CLIA NUMBER - CHILDRENS HEALTHCARE CENTER

Laboratory Demographics

CLIA Number: 11D1040215

Facility Name: CHILDRENS HEALTHCARE CENTER

Facility Address:
610 FERNCREST DRIVE
SANDERSVILLE, GA
ZIP 31082
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Facility Phone Number: 478 552-0006

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1740319623

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	11D1040215
LAB Type	Physician Office
Facility Name	CHILDRENS HEALTHCARE CENTER
Street	610 FERNCREST DRIVE
City	SANDERSVILLE
State	GA
ZIP	31082
Phone	478 552-0006
CertificateType	4
CertificateEffectiveDate	3/30/2023
CertificateExpirationDate	3/29/2025
FacilityType	Waiver

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