11D2200411 CLIA NUMBER - BRANTLEY CO GA JAIL

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Laboratory Demographics

CLIA Number: 11D2200411

Facility Name: BRANTLEY CO GA JAIL

Facility Address:
95 JOHN WILSON STREET
NAHUNTA, GA
ZIP 31553
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Facility Phone Number: 912 490-7779

Facility Type: Other - JAIL

Certificate Type: Waiver

NPI Number: 1730116120

Taxonomy: 251K00000X - Public Health or Welfare

CLIA Record

Field Name	Field Value
CLIA Number	11D2200411
LAB Type	Other - JAIL
Facility Name	BRANTLEY CO GA JAIL
Street	95 JOHN WILSON STREET
City	NAHUNTA
State	GA
ZIP	31553
Phone	912 490-7779
CertificateType	4
CertificateEffectiveDate	11/16/2022
CertificateExpirationDate	11/15/2024
FacilityType	Waiver

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