11D2071174 CLIA NUMBER - ONESOURCE HEALTHCARE GROUP, LLC

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Laboratory Demographics

CLIA Number: 11D2071174

Facility Name: ONESOURCE HEALTHCARE GROUP, LLC

Facility Address:
701 N SLAPPEY BLVD
ALBANY, GA
ZIP 31701
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Facility Phone Number: 229 439-1950

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1174950117

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	11D2071174
LAB Type	Physician Office
Facility Name	ONESOURCE HEALTHCARE GROUP, LLC
Street	701 N SLAPPEY BLVD
City	ALBANY
State	GA
ZIP	31701
Phone	229 439-1950
CertificateType	4
CertificateEffectiveDate	1/6/2024
CertificateExpirationDate	1/5/2026
FacilityType	Waiver

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