11D2104790 CLIA NUMBER - ALICE COACHMAN ELEMENTARY SCHOOL BASED HEALTH CTR

Laboratory Demographics

CLIA Number: 11D2104790

Facility Name: ALICE COACHMAN ELEMENTARY SCHOOL BASED HEALTH CTR

Facility Address:
1425 W OAKRIDGE DR
ALBANY, GA
ZIP 31707
Get Directions

Facility Phone Number: 229 883-6860

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1003287731

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2104790
LAB Type	Federally Qualified Health Center
Facility Name	ALICE COACHMAN ELEMENTARY SCHOOL BASED HEALTH CTR
Street	1425 W OAKRIDGE DR
City	ALBANY
State	GA
ZIP	31707
Phone	229 883-6860
CertificateType	4
CertificateEffectiveDate	11/12/2023
CertificateExpirationDate	11/11/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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