11D1093590 CLIA NUMBER - WASHINGTON COUNTY FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 11D1093590
  • Facility Name: WASHINGTON COUNTY FAMILY PRACTICE
  • Facility Address: 610 FERNCREST DRIVE
    SANDERSVILLE, GA
    ZIP 31082
  • Facility Phone: 478 552-9000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EARLE M. TAYLOR
  • NPI Number: 1033145313
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1093590
LAB Type Physician Office
Facility Name WASHINGTON COUNTY FAMILY PRACTICE
Street 610 FERNCREST DRIVE
City SANDERSVILLE
State GA
ZIP 31082
Phone 478 552-9000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/23/2024
Certificate Expiration Date 12/22/2026
Facility Type Physician Office
Lab Director EARLE M. TAYLOR

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