11D1103712 CLIA NUMBER - FORD CLINIC

Laboratory Demographics

CLIA Number: 11D1103712

Facility Name: FORD CLINIC

Facility Address:
930 FRANKLIN SPRINGS STREET
ROYSTON, GA
ZIP 30662
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Facility Phone Number: 706 356-8181

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1710965900

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D1103712
LAB Type	Physician Office
Facility Name	FORD CLINIC
Street	930 FRANKLIN SPRINGS STREET
City	ROYSTON
State	GA
ZIP	30662
Phone	706 356-8181
CertificateType	4
CertificateEffectiveDate	8/17/2023
CertificateExpirationDate	8/16/2025
FacilityType	Waiver

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