11D2003613 CLIA NUMBER - AIR EVAC 090

Laboratory Demographics

  • CLIA Code: 11D2003613
  • Facility Name: AIR EVAC 090
  • Facility Address: 195 THOMAS FRIER DRIVE
    DOUGLAS, GA
    ZIP 31535
  • Facility Phone: 912 384-0393
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: B SCOTT MOSELEY
  • NPI Number: 1881924066
  • Taxonomy: 3416A0800X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 11D2003613
LAB Type Ambulance
Facility Name AIR EVAC 090
Street 195 THOMAS FRIER DRIVE
City DOUGLAS
State GA
ZIP 31535
Phone 912 384-0393
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/15/2024
Certificate Expiration Date 2/14/2026
Facility Type Ambulance
Lab Director B SCOTT MOSELEY

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