11D1081884 CLIA NUMBER - PRIMARY HEALTHCARE CENTER FORT OGLETHORPE

Laboratory Demographics

CLIA Number: 11D1081884

Facility Name: PRIMARY HEALTHCARE CENTER FORT OGLETHORPE

Facility Address:
2009 OLD LAFAYETTE ROAD
FORT OGLETHORPE, GA
ZIP 30742
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Facility Phone Number: 706 866-5520

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1235505678

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D1081884
LAB Type	Federally Qualified Health Center
Facility Name	PRIMARY HEALTHCARE CENTER FORT OGLETHORPE
Street	2009 OLD LAFAYETTE ROAD
City	FORT OGLETHORPE
State	GA
ZIP	30742
Phone	706 866-5520
CertificateType	4
CertificateEffectiveDate	11/1/2022
CertificateExpirationDate	10/31/2024
FacilityType	Waiver

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