11D2014321 CLIA NUMBER - FAMILY MEDICINE OF POOLER, LLC

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Laboratory Demographics

CLIA Number: 11D2014321

Facility Name: FAMILY MEDICINE OF POOLER, LLC

Facility Address:
433 US HIGHWAY 80 US
POOLER, GA
ZIP 31322
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Facility Phone Number: 912 748-1100

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1275848533

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2014321
LAB Type	Physician Office
Facility Name	FAMILY MEDICINE OF POOLER, LLC
Street	433 US HIGHWAY 80 US
City	POOLER
State	GA
ZIP	31322
Phone	912 748-1100
CertificateType	4
CertificateEffectiveDate	10/6/2022
CertificateExpirationDate	10/5/2024
FacilityType	Waiver

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