11D2240048 CLIA NUMBER - INFUSE AESTHETICS AND WELLNESS, LLC

Laboratory Demographics

CLIA Number: 11D2240048

Facility Name: INFUSE AESTHETICS AND WELLNESS, LLC

Facility Address:
721 E SHOTWELL STREET
BAINBRIDGE, GA
ZIP 39819
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Facility Phone Number: 229 400-9260

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1326710526

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	11D2240048
LAB Type	Physician Office
Facility Name	INFUSE AESTHETICS AND WELLNESS, LLC
Street	721 E SHOTWELL STREET
City	BAINBRIDGE
State	GA
ZIP	39819
Phone	229 400-9260
CertificateType	4
CertificateEffectiveDate	10/15/2023
CertificateExpirationDate	10/14/2025
FacilityType	Waiver

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