11D2165830 CLIA NUMBER - PROVIDENCE SNF OPERATOR, LLC DBA PROVIDENCE HEALTHCARE

Laboratory Demographics

  • CLIA Code: 11D2165830
  • Facility Name: PROVIDENCE SNF OPERATOR, LLC DBA PROVIDENCE HEALTHCARE
  • Facility Address: 1011 SOUTH GREEN STREET
    THOMASTON, GA
    ZIP 30286
  • Facility Phone: 706 647-6693
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JONATHAN F. BUSBEE
  • NPI Number: 1497195051
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D2165830
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PROVIDENCE SNF OPERATOR, LLC DBA PROVIDENCE HEALTHCARE
Street 1011 SOUTH GREEN STREET
City THOMASTON
State GA
ZIP 30286
Phone 706 647-6693
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/7/2025
Certificate Expiration Date 5/6/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director JONATHAN F. BUSBEE

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This page was last updated on: 9/29/2025