10D2263948 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP, LLC

Laboratory Demographics

  • CLIA Code: 10D2263948
  • Facility Name: MILLENNIUM PHYSICIAN GROUP, LLC
  • Facility Address: 10131 SAN JOSE BLVD UNIT 24
    JACKSONVILLE, FL
    ZIP 32257
  • Facility Phone: 941 787-7665
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: WISSAM SHAYA
  • NPI Number: 1174295927
  • Taxonomy: 207Q00000X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 10D2263948
LAB Type Physician Office
Facility Name MILLENNIUM PHYSICIAN GROUP, LLC
Street 10131 SAN JOSE BLVD UNIT 24
City JACKSONVILLE
State FL
ZIP 32257
Phone 941 787-7665
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/7/2024
Certificate Expiration Date 7/6/2026
Facility Type Physician Office
Lab Director WISSAM SHAYA

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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