11D2220491 CLIA NUMBER - PREMISE HEALTH OF GEORGIA MEDICAL, PC

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Laboratory Demographics

CLIA Number: 11D2220491

Facility Name: PREMISE HEALTH OF GEORGIA MEDICAL, PC

Facility Address:
8801 MACON ROAD
COLUMBUS, GA
ZIP 31908
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Facility Phone Number: 706 568-5850

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1871915918

Taxonomy: 261QX0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2220491
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF GEORGIA MEDICAL, PC
Street	8801 MACON ROAD
City	COLUMBUS
State	GA
ZIP	31908
Phone	706 568-5850
CertificateType	4
CertificateEffectiveDate	4/13/2023
CertificateExpirationDate	4/12/2025
FacilityType	Waiver

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