11D1099601 CLIA NUMBER - SOUTH GEORGIA PEDIATRICS PC

Laboratory Demographics

CLIA Number: 11D1099601

Facility Name: SOUTH GEORGIA PEDIATRICS PC

Facility Address:
1230 BRAMPTON AVENUE
STATESBORO, GA
ZIP 30458
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Facility Phone Number: 912 489-5437

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1578797627

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	11D1099601
LAB Type	Physician Office
Facility Name	SOUTH GEORGIA PEDIATRICS PC
Street	1230 BRAMPTON AVENUE
City	STATESBORO
State	GA
ZIP	30458
Phone	912 489-5437
CertificateType	4
CertificateEffectiveDate	5/18/2023
CertificateExpirationDate	5/17/2025
FacilityType	Waiver

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