11D0929763 CLIA NUMBER - GRACE V DAVIS MD PC

Laboratory Demographics

  • CLIA Code: 11D0929763
  • Facility Name: GRACE V DAVIS MD PC
  • Facility Address: 203 WEST KELLY STREET
    SYLVESTER, GA
    ZIP 31791
  • Facility Phone: 912 777-0488
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: GRACE V. DAVIS MD
  • NPI Number: 1679534945
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D0929763
LAB Type Rural Health Clinic
Facility Name GRACE V DAVIS MD PC
Street 203 WEST KELLY STREET
City SYLVESTER
State GA
ZIP 31791
Phone 912 777-0488
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/24/2025
Certificate Expiration Date 6/23/2027
Facility Type Rural Health Clinic
Lab Director GRACE V. DAVIS MD

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