11D0980034 CLIA NUMBER - FAMILY PRACTICE ASSOCIATES OF TIFTAREA LLC

Laboratory Demographics

  • CLIA Code: 11D0980034
  • Facility Name: FAMILY PRACTICE ASSOCIATES OF TIFTAREA LLC
  • Facility Address: 612 LOVE AVE
    TIFTON, GA
    ZIP 31794
  • Facility Phone: 229 391-3300
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JENNINE GOMEZ
  • NPI Number: 1972725216
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 11D0980034
LAB Type Physician Office
Facility Name FAMILY PRACTICE ASSOCIATES OF TIFTAREA LLC
Street 612 LOVE AVE
City TIFTON
State GA
ZIP 31794
Phone 229 391-3300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/9/2024
Certificate Expiration Date 11/8/2026
Facility Type Physician Office
Lab Director JENNINE GOMEZ

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