11D0261439 CLIA NUMBER - MARY BETH WILES MD

Laboratory Demographics

  • CLIA Code: 11D0261439
  • Facility Name: MARY BETH WILES MD
  • Facility Address: 374A PAT HARALSON DRIVE
    BLAIRSVILLE, GA
    ZIP 30512
  • Facility Phone: 706 745-5541
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARYBETH WILES
  • NPI Number: 1982702999
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0261439
LAB Type Physician Office
Facility Name MARY BETH WILES MD
Street 374A PAT HARALSON DRIVE
City BLAIRSVILLE
State GA
ZIP 30512
Phone 706 745-5541
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director MARYBETH WILES

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