11D1058495 CLIA NUMBER - BENNIE R WHITE JUNIOR MD INCORPORATED

Laboratory Demographics

  • CLIA Code: 11D1058495
  • Facility Name: BENNIE R WHITE JUNIOR MD INCORPORATED
  • Facility Address: 794 MCDONOUGH ROAD SUITE 105
    JACKSON, GA
    ZIP 30233
  • Facility Phone: 770 775-2341
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BENNIE WHITE MD
  • NPI Number: 1376575225
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1058495
LAB Type Physician Office
Facility Name BENNIE R WHITE JUNIOR MD INCORPORATED
Street 794 MCDONOUGH ROAD SUITE 105
City JACKSON
State GA
ZIP 30233
Phone 770 775-2341
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/15/2023
Certificate Expiration Date 12/14/2025
Facility Type Physician Office
Lab Director BENNIE WHITE MD

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