11D1103402 CLIA NUMBER - CARECONNECT FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 11D1103402

Facility Name: CARECONNECT FAMILY PRACTICE

Facility Address:
712 N 7TH STREET
CORDELE, GA
ZIP 31015
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Facility Phone Number: 229 276-0052

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1457581738

Taxonomy: 261QF0400X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	8/11/2023
CertificateExpirationDate	8/10/2025
FacilityType	Waiver

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