11D0726449 CLIA NUMBER - SWAINSBORO INTERNAL MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 11D0726449

Facility Name: SWAINSBORO INTERNAL MEDICAL CLINIC

Facility Address:
131 A VICTORY DRIVE
SWAINSBORO, GA
ZIP 30401
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Facility Phone Number: 478 237-8342

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1366784415

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D0726449
LAB Type	Physician Office
Facility Name	SWAINSBORO INTERNAL MEDICAL CLINIC
Street	131 A VICTORY DRIVE
City	SWAINSBORO
State	GA
ZIP	30401
Phone	478 237-8342
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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