11D0930063 CLIA NUMBER - TIFT INTERNAL MEDICINE CENTER LLC

Laboratory Demographics

  • CLIA Code: 11D0930063
  • Facility Name: TIFT INTERNAL MEDICINE CENTER LLC
  • Facility Address: 39 KENT ROAD, SUITE 1
    TIFTON, GA
    ZIP 31794
  • Facility Phone: 229 391-3555
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRENT A. SAVELLI
  • NPI Number: 1568499762
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0930063
LAB Type Physician Office
Facility Name TIFT INTERNAL MEDICINE CENTER LLC
Street 39 KENT ROAD, SUITE 1
City TIFTON
State GA
ZIP 31794
Phone 229 391-3555
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/5/2024
Certificate Expiration Date 5/4/2026
Facility Type Physician Office
Lab Director BRENT A. SAVELLI

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