11D1015785 CLIA NUMBER - DEWITT AND CHISOLM LLC

Laboratory Demographics

  • CLIA Code: 11D1015785
  • Facility Name: DEWITT AND CHISOLM LLC
  • Facility Address: 1500 OGLETHORPE AVE, SUITE 3300
    ATHENS, GA
    ZIP 30606
  • Facility Phone: 706 208-1406
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HENRY L. DEWITT
  • NPI Number: 1306910047
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1015785
LAB Type Physician Office
Facility Name DEWITT AND CHISOLM LLC
Street 1500 OGLETHORPE AVE, SUITE 3300
City ATHENS
State GA
ZIP 30606
Phone 706 208-1406
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/13/2023
Certificate Expiration Date 8/12/2025
Facility Type Physician Office
Lab Director HENRY L. DEWITT

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This page was last updated on: 3/20/2025