11D0933792 CLIA NUMBER - JOSE MEDINA MD

Laboratory Demographics

  • CLIA Code: 11D0933792
  • Facility Name: JOSE MEDINA MD
  • Facility Address: 3334 GREYSTONE WAY
    VALDOSTA, GA
    ZIP 31602
  • Facility Phone: 229 247-1667
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOSE MEDINA
  • NPI Number: 1417944513
  • Taxonomy: 207RP1001X - Internal Medicine

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/19/2025
Certificate Expiration Date 1/18/2027
Facility Type Physician Office
Lab Director JOSE MEDINA

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