11D2259137 CLIA NUMBER - MACON STATE PRISON

Laboratory Demographics

  • CLIA Code: 11D2259137
  • Facility Name: MACON STATE PRISON
  • Facility Address: 2728 HIGHWAY 49 SOUTH
    OGELTHORPE, GA
    ZIP 31068
  • Facility Phone: 678 470-3977
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: PAMELA MAXIE
  • NPI Number: 1316438393
  • Taxonomy: 3336I0012X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2259137
LAB Type Prison
Facility Name MACON STATE PRISON
Street 2728 HIGHWAY 49 SOUTH
City OGELTHORPE
State GA
ZIP 31068
Phone 678 470-3977
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/3/2024
Certificate Expiration Date 5/2/2026
Facility Type Prison
Lab Director PAMELA MAXIE

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