11D1103402 CLIA NUMBER - CARECONNECT FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 11D1103402
  • Facility Name: CARECONNECT FAMILY PRACTICE
  • Facility Address: 712 N 7TH STREET
    CORDELE, GA
    ZIP 31015
  • Facility Phone: 229 276-0052
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: PARVIZ BRAHMAN
  • NPI Number: 1457581738
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1103402
LAB Type Federally Qualified Health Center
Facility Name CARECONNECT FAMILY PRACTICE
Street 712 N 7TH STREET
City CORDELE
State GA
ZIP 31015
Phone 229 276-0052
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/11/2023
Certificate Expiration Date 8/10/2025
Facility Type Federally Qualified Health Center
Lab Director PARVIZ BRAHMAN

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This page was last updated on: 6/4/2025