11D0700472 CLIA NUMBER - ARCHBOLD PRIMARY CARE

Laboratory Demographics

CLIA Number: 11D0700472

Facility Name: ARCHBOLD PRIMARY CARE

Facility Address:
2621 E PINETREE BLVD
THOMASVILLE, GA
ZIP 31792
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Facility Phone Number: 229 226-5788

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1508132887

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	11D0700472
LAB Type	Physician Office
Facility Name	ARCHBOLD PRIMARY CARE
Street	2621 E PINETREE BLVD
City	THOMASVILLE
State	GA
ZIP	31792
Phone	229 226-5788
CertificateType	3
CertificateEffectiveDate	1/6/2023
CertificateExpirationDate	1/5/2025
FacilityType	PPMP

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This page was last updated on: 4/23/2024