11D2143141 CLIA NUMBER - LIVE OAK ELEMENTARY SCHOOL BASED HEALTH CENTER

Laboratory Demographics

CLIA Number: 11D2143141

Facility Name: LIVE OAK ELEMENTARY SCHOOL BASED HEALTH CENTER

Facility Address:
4529 GILLIONVILLE ROAD
ALBANY, GA
ZIP 31721
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Facility Phone Number: 229 405-6188

Facility Type: Tissue Bank/Repositories

Certificate Type: Waiver

NPI Number: 1467967588

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2143141
LAB Type	Tissue Bank/Repositories
Facility Name	LIVE OAK ELEMENTARY SCHOOL BASED HEALTH CENTER
Street	4529 GILLIONVILLE ROAD
City	ALBANY
State	GA
ZIP	31721
Phone	229 405-6188
CertificateType	4
CertificateEffectiveDate	1/25/2024
CertificateExpirationDate	1/24/2026
FacilityType	Waiver

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