11D0955916 CLIA NUMBER - PEACH CARE LLC

Laboratory Demographics

  • CLIA Code: 11D0955916
  • Facility Name: PEACH CARE LLC
  • Facility Address: 2383 THIRD ST
    FOLKSTON, GA
    ZIP 31537
  • Facility Phone: 912 496-1155
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MAGED E. ABDELMALIK
  • NPI Number: 1730598491
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0955916
LAB Type Physician Office
Facility Name PEACH CARE LLC
Street 2383 THIRD ST
City FOLKSTON
State GA
ZIP 31537
Phone 912 496-1155
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/13/2025
Certificate Expiration Date 1/12/2027
Facility Type Physician Office
Lab Director MAGED E. ABDELMALIK

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