11D1046157 CLIA NUMBER - WIGGINS FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 11D1046157

Facility Name: WIGGINS FAMILY PRACTICE

Facility Address:
205 ARLINGTON AVENUE
VIDALIA, GA
ZIP 30474
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Facility Phone Number: 912 537-2530

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1316126139

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	11D1046157
LAB Type	Physician Office
Facility Name	WIGGINS FAMILY PRACTICE
Street	205 ARLINGTON AVENUE
City	VIDALIA
State	GA
ZIP	30474
Phone	912 537-2530
CertificateType	4
CertificateEffectiveDate	10/3/2023
CertificateExpirationDate	10/2/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024