11D1012165 CLIA NUMBER - MCCAYSVILLE INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 11D1012165
  • Facility Name: MCCAYSVILLE INTERNAL MEDICINE
  • Facility Address: 6 ELM STREET
    BLUE RIDGE, GA
    ZIP 30513
  • Facility Phone: 706 492-4294
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RONALD T. JABALEY II
  • NPI Number: 1477574473
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1012165
LAB Type Physician Office
Facility Name MCCAYSVILLE INTERNAL MEDICINE
Street 6 ELM STREET
City BLUE RIDGE
State GA
ZIP 30513
Phone 706 492-4294
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/2/2025
Certificate Expiration Date 5/1/2027
Facility Type Physician Office
Lab Director RONALD T. JABALEY II

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