11D0673460 CLIA NUMBER - FLINT RIVER RURAL HEALTH CLINIC

Laboratory Demographics

  • CLIA Code: 11D0673460
  • Facility Name: FLINT RIVER RURAL HEALTH CLINIC
  • Facility Address: 502 SUMTER STREET
    MONTEZUMA, GA
    ZIP 31063
  • Facility Phone: 912 472-8178
  • Facility Type: Rural Health Clinic
  • Facility Type: Microscopy
  • Lab Director: QUINCY J. JORDAN
  • NPI Number: 1336373208
  • Taxonomy: 261QA0600X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0673460
LAB Type Rural Health Clinic
Facility Name FLINT RIVER RURAL HEALTH CLINIC
Street 502 SUMTER STREET
City MONTEZUMA
State GA
ZIP 31063
Phone 912 472-8178
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 7/15/2024
Certificate Expiration Date 7/14/2026
Facility Type Rural Health Clinic
Lab Director QUINCY J. JORDAN

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