11D2009817 CLIA NUMBER - STATESBORO IMAGING CENTER, PC

Laboratory Demographics

  • CLIA Code: 11D2009817
  • Facility Name: STATESBORO IMAGING CENTER, PC
  • Facility Address: 8 LESTER ROAD
    STATESBORO, GA
    ZIP 30458
  • Facility Phone: 912 764-5656
  • Facility Type: Other - IDTF (IN PROCESS)
  • Facility Type: Waiver
  • Lab Director: DR. ANJANA VIJAYVARGIYA
  • NPI Number: 1811217920
  • Taxonomy: 293D00000X - Physiological Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 11D2009817
LAB Type Other - IDTF (IN PROCESS)
Facility Name STATESBORO IMAGING CENTER, PC
Street 8 LESTER ROAD
City STATESBORO
State GA
ZIP 30458
Phone 912 764-5656
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/15/2024
Certificate Expiration Date 7/14/2026
Facility Type Other - IDTF (IN PROCESS)
Lab Director DR. ANJANA VIJAYVARGIYA

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