11D2244776 CLIA NUMBER - AUGUSTA ANTI-AGING MEDICINE, LLC

Laboratory Demographics

  • CLIA Code: 11D2244776
  • Facility Name: AUGUSTA ANTI-AGING MEDICINE, LLC
  • Facility Address: 501 FURY'S FERRY ROAD
    AUGUSTA, GA
    ZIP 30907
  • Facility Phone: 706 707-2808
  • Facility Type: Practitioner Other
  • Facility Type: Microscopy
  • Lab Director: SAMANTHA S. TOJINO
  • NPI Number: 1568047876
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 11D2244776
LAB Type Practitioner Other
Facility Name AUGUSTA ANTI-AGING MEDICINE, LLC
Street 501 FURY'S FERRY ROAD
City AUGUSTA
State GA
ZIP 30907
Phone 706 707-2808
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/6/2023
Certificate Expiration Date 12/5/2025
Facility Type Practitioner Other
Lab Director SAMANTHA S. TOJINO

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