11D0266091 CLIA NUMBER - SOUTHWEST GEORGIA HEALTHCARE CLINICS INC

Laboratory Demographics

  • CLIA Code: 11D0266091
  • Facility Name: SOUTHWEST GEORGIA HEALTHCARE CLINICS INC
  • Facility Address: 804 N WILEY AVENUE
    DONALSONVILLE, GA
    ZIP 39845
  • Facility Phone: 229 424-2808
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HOMER E. BRECKENRIDGE III
  • NPI Number: 1922752427
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 11D0266091
LAB Type Physician Office
Facility Name SOUTHWEST GEORGIA HEALTHCARE CLINICS INC
Street 804 N WILEY AVENUE
City DONALSONVILLE
State GA
ZIP 39845
Phone 229 424-2808
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 HOMER E. BRECKENRIDGE III

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