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11D0943174 CLIA NUMBER - APPLING MEDICAL GROUP- DR O V FERNANDO

Laboratory Demographics

CLIA Number: 11D0943174

Facility Name: APPLING MEDICAL GROUP- DR O V FERNANDO

Facility Address:
105 E TOLLISON STREET, SUITE B
BAXLEY, GA
ZIP 31513
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Facility Phone Number: 912 367-0102

Facility Type: Rural Health Clinic

Certificate Type: Microscopy
NPI Number: 1073752143

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name Field Value
CLIA Number 11D0943174
LAB Type Rural Health Clinic
Facility Name APPLING MEDICAL GROUP- DR O V FERNANDO
Street 105 E TOLLISON STREET, SUITE B
City BAXLEY
State GA
ZIP 31513
Phone 912 367-0102
CertificateType 3
CertificateEffectiveDate 3/24/2024
CertificateExpirationDate 3/23/2026
FacilityType PPMP

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