11D2275542 CLIA NUMBER - IVY COLLABORATIVE HEALTHCARE, LLC

Laboratory Demographics

  • CLIA Code: 11D2275542
  • Facility Name: IVY COLLABORATIVE HEALTHCARE, LLC
  • Facility Address: 2100 CENTRAL AVENUE, SUITE 6
    AUGUSTA, GA
    ZIP 30904
  • Facility Phone: 706 364-3461
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOCELYN K. BAYLISS
  • NPI Number: 1043845373
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 11D2275542
LAB Type Physician Office
Facility Name IVY COLLABORATIVE HEALTHCARE, LLC
Street 2100 CENTRAL AVENUE, SUITE 6
City AUGUSTA
State GA
ZIP 30904
Phone 706 364-3461
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/24/2025
Certificate Expiration Date 1/23/2027
Facility Type Physician Office
Lab Director JOCELYN K. BAYLISS

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This page was last updated on: 6/4/2025