11D0922663 CLIA NUMBER - RAYMOND J OTIS SENIOR PC

Laboratory Demographics

  • CLIA Code: 11D0922663
  • Facility Name: RAYMOND J OTIS SENIOR PC
  • Facility Address: 24 NORTH ELLIS STREET
    CAMILLA, GA
    ZIP 31730
  • Facility Phone: 229 336-7343
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SR. RAYMOND J. OTIS
  • NPI Number: 1104844422
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0922663
LAB Type Physician Office
Facility Name RAYMOND J OTIS SENIOR PC
Street 24 NORTH ELLIS STREET
City CAMILLA
State GA
ZIP 31730
Phone 229 336-7343
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/25/2024
Certificate Expiration Date 3/24/2026
Facility Type Physician Office
Lab Director SR. RAYMOND J. OTIS

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