11D0989043 CLIA NUMBER - BENNETT P HOGAN MD PC

Laboratory Demographics

  • CLIA Code: 11D0989043
  • Facility Name: BENNETT P HOGAN MD PC
  • Facility Address: 117 WEST NORTHSIDE DRIVE
    VALDOSTA, GA
    ZIP 31602
  • Facility Phone: (229) 333-0616
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BENNETT P. HOGAN
  • NPI Number: 1134184864
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0989043
LAB Type Physician Office
Facility Name BENNETT P HOGAN MD PC
Street 117 WEST NORTHSIDE DRIVE
City VALDOSTA
State GA
ZIP 31602
Phone 2293330616
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/16/2025
Certificate Expiration Date 7/15/2027
Facility Type Physician Office
Lab Director BENNETT P. HOGAN

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This page was last updated on: 5/18/2026