11D0933792 CLIA NUMBER - JOSE MEDINA MD

Laboratory Demographics

CLIA Number: 11D0933792

Facility Name: JOSE MEDINA MD

Facility Address:
3334 GREYSTONE WAY
VALDOSTA, GA
ZIP 31602
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Facility Phone Number: 229 247-1667

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1417944513

Taxonomy: 207RP1001X - Internal Medicine
An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.

CLIA Record

Field Name	Field Value
CLIA Number	11D0933792
LAB Type	Physician Office
Facility Name	JOSE MEDINA MD
Street	3334 GREYSTONE WAY
City	VALDOSTA
State	GA
ZIP	31602
Phone	229 247-1667
CertificateType	4
CertificateEffectiveDate	1/19/2023
CertificateExpirationDate	1/18/2025
FacilityType	Waiver

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