11D0963764 CLIA NUMBER - LAGRANGE MED CENTER

Laboratory Demographics

  • CLIA Code: 11D0963764
  • Facility Name: LAGRANGE MED CENTER
  • Facility Address: 309 VERNON STREET
    LAGRANGE, GA
    ZIP 30240
  • Facility Phone: 706 885-9110
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GARY R. SOLT
  • NPI Number: 1043318355
  • Taxonomy: 207Q00000X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D0963764
LAB Type Physician Office
Facility Name LAGRANGE MED CENTER
Street 309 VERNON STREET
City LAGRANGE
State GA
ZIP 30240
Phone 706 885-9110
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/10/2025
Certificate Expiration Date 8/9/2027
Facility Type Physician Office
Lab Director GARY R. SOLT

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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