11D0997764 CLIA NUMBER - WALTON COUNTY JAIL MEDICAL

Laboratory Demographics

  • CLIA Code: 11D0997764
  • Facility Name: WALTON COUNTY JAIL MEDICAL
  • Facility Address: 1425 SOUTH MADISON AVENUE MEDICAL DEPARTMENT
    MONROE, GA
    ZIP 30655
  • Facility Phone: 770 267-2333
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: TRACY MOULDER LPN MTA
  • NPI Number: 1164599346
  • Taxonomy: 332U00000X - Home Delivered Meals

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CLIA Record

Field Name Field Value
CLIA Number 11D0997764
LAB Type Rural Health Clinic
Facility Name WALTON COUNTY JAIL MEDICAL
Street 1425 SOUTH MADISON AVENUE MEDICAL DEPARTMENT
City MONROE
State GA
ZIP 30655
Phone 770 267-2333
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/27/2024
Certificate Expiration Date 3/26/2026
Facility Type Rural Health Clinic
Lab Director TRACY MOULDER LPN MTA

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