10D2316851 CLIA NUMBER - SOUTHERN BREEZE PRIMARY CARE LLC

Laboratory Demographics

  • CLIA Code: 10D2316851
  • Facility Name: SOUTHERN BREEZE PRIMARY CARE LLC
  • Facility Address: 107 W 19TH ST STE B
    PANAMA CITY, FL
    ZIP 32405
  • Facility Phone: 850 248-8002
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: HOLLY GAY
  • NPI Number: 1881776730
  • Taxonomy: 133V00000X - Dietitian, Registered

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CLIA Record

Field Name Field Value
CLIA Number 10D2316851
LAB Type Practitioner Other
Facility Name SOUTHERN BREEZE PRIMARY CARE LLC
Street 107 W 19TH ST STE B
City PANAMA CITY
State FL
ZIP 32405
Phone 850 248-8002
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/14/2025
Certificate Expiration Date 1/13/2027
Facility Type Practitioner Other
Lab Director HOLLY GAY

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