11D1058990 CLIA NUMBER - HEALTHSTAT INCORPORATED ON SITE CLINIC MOUNT VERNON MILLS

Laboratory Demographics

  • CLIA Code: 11D1058990
  • Facility Name: HEALTHSTAT INCORPORATED ON SITE CLINIC MOUNT VERNON MILLS
  • Facility Address: 91 4TH STREET
    TRION, GA
    ZIP 30753
  • Facility Phone: 704 529-6161
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: ROBERT E. HART MD
  • NPI Number: 1508132614
  • Taxonomy: 2083P0500X - Preventive Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1058990
LAB Type Other
Facility Name HEALTHSTAT INCORPORATED ON SITE CLINIC MOUNT VERNON MILLS
Street 91 4TH STREET
City TRION
State GA
ZIP 30753
Phone 704 529-6161
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/20/2024
Certificate Expiration Date 9/19/2026
Facility Type Other
Lab Director ROBERT E. HART MD

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