11D1022317 CLIA NUMBER - SOPERTON - EAST GEORGIA HEALTHCARE CENTER

Laboratory Demographics

  • CLIA Code: 11D1022317
  • Facility Name: SOPERTON - EAST GEORGIA HEALTHCARE CENTER
  • Facility Address: 4357 LOUISIANA AVENUE
    SOPERTON, GA
    ZIP 30457
  • Facility Phone: 912 529-5533
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: EMILY TATUM
  • NPI Number: 1558339838
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 11D1022317
LAB Type Federally Qualified Health Center
Facility Name SOPERTON - EAST GEORGIA HEALTHCARE CENTER
Street 4357 LOUISIANA AVENUE
City SOPERTON
State GA
ZIP 30457
Phone 912 529-5533
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/7/2024
Certificate Expiration Date 6/6/2026
Facility Type Federally Qualified Health Center
Lab Director EMILY TATUM

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