11D2170255 CLIA NUMBER - SUMMERVILLE OCCUPATIONAL NURSE OFFICE

Laboratory Demographics

CLIA Number: 11D2170255

Facility Name: SUMMERVILLE OCCUPATIONAL NURSE OFFICE

Facility Address:
106 JOHN BANKSTON DRIVE
SUMMERVILLE, GA
ZIP 30747
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Facility Phone Number: 480 868-0646

Facility Type: Other - OUT PATIENT

Certificate Type: Waiver

NPI Number: 1336339076

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	11D2170255
LAB Type	Other - OUT PATIENT
Facility Name	SUMMERVILLE OCCUPATIONAL NURSE OFFICE
Street	106 JOHN BANKSTON DRIVE
City	SUMMERVILLE
State	GA
ZIP	30747
Phone	480 868-0646
CertificateType	4
CertificateEffectiveDate	8/7/2023
CertificateExpirationDate	8/6/2025
FacilityType	Waiver

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