11D0265545 CLIA NUMBER - SOUTHWELL AMBULATORY, INC DBA SOUTHWELL INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 11D0265545
  • Facility Name: SOUTHWELL AMBULATORY, INC DBA SOUTHWELL INTERNAL MEDICINE
  • Facility Address: 3014 NORTH PATTERSON ST
    VALDOSTA, GA
    ZIP 31602
  • Facility Phone: 229 353-7535
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LYNN S. LEE
  • NPI Number: 1598304974
  • Taxonomy: 207RI0200X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0265545
LAB Type Physician Office
Facility Name SOUTHWELL AMBULATORY, INC DBA SOUTHWELL INTERNAL MEDICINE
Street 3014 NORTH PATTERSON ST
City VALDOSTA
State GA
ZIP 31602
Phone 229 353-7535
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/1/2025
Certificate Expiration Date 1/31/2027
Facility Type Physician Office
Lab Director LYNN S. LEE

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