11D2261983 CLIA NUMBER - PULASKI STATE PRISON

Laboratory Demographics

  • CLIA Code: 11D2261983
  • Facility Name: PULASKI STATE PRISON
  • Facility Address: 373 UPPER RIVER ROAD
    HAWKINSVILLE, GA
    ZIP 31036
  • Facility Phone: 678 470-3977
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: MELLIE ANDERSON
  • NPI Number: 1902397995
  • Taxonomy: 3336I0012X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2261983
LAB Type Prison
Facility Name PULASKI STATE PRISON
Street 373 UPPER RIVER ROAD
City HAWKINSVILLE
State GA
ZIP 31036
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 6/8/2024
Certificate Expiration Date 6/7/2026
Facility Type Prison
Lab Director MELLIE ANDERSON

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