11D1015745 CLIA NUMBER - MIDDLE FLINT COMMUNITY SERVICE BOARD

Laboratory Demographics

  • CLIA Code: 11D1015745
  • Facility Name: MIDDLE FLINT COMMUNITY SERVICE BOARD
  • Facility Address: 415 NORTH JACKSON STREET
    AMERICUS, GA
    ZIP 31709
  • Facility Phone: 478 919-0273
  • Facility Type: Other - COMMUNITY SERVICE BOARD
  • Facility Type: Waiver
  • Lab Director: ERIC FAN
  • NPI Number: 1053589176
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 11D1015745
LAB Type Other - COMMUNITY SERVICE BOARD
Facility Name MIDDLE FLINT COMMUNITY SERVICE BOARD
Street 415 NORTH JACKSON STREET
City AMERICUS
State GA
ZIP 31709
Phone 478 919-0273
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/12/2025
Certificate Expiration Date 8/11/2027
Facility Type Other - COMMUNITY SERVICE BOARD
Lab Director ERIC FAN

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