11D1077243 CLIA NUMBER - OCONEE WHOLESOME MEDICAL, LLC

Laboratory Demographics

  • CLIA Code: 11D1077243
  • Facility Name: OCONEE WHOLESOME MEDICAL, LLC
  • Facility Address: 1800 HOG MOUNTAIN RD, BUILDING 600, SUITE 103
    WATKINSVILLE, GA
    ZIP 30677
  • Facility Phone: 706 769-8800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NEDSELY A. VILA
  • NPI Number: 1891971859
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1077243
LAB Type Physician Office
Facility Name OCONEE WHOLESOME MEDICAL, LLC
Street 1800 HOG MOUNTAIN RD, BUILDING 600, SUITE 103
City WATKINSVILLE
State GA
ZIP 30677
Phone 706 769-8800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/5/2023
Certificate Expiration Date 12/4/2025
Facility Type Physician Office
Lab Director NEDSELY A. VILA

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