11D2030008 CLIA NUMBER - DODGE CO HOSP AUTH DBA EASTMAN FAMILY PRACTICE LLC

Laboratory Demographics

  • CLIA Code: 11D2030008
  • Facility Name: DODGE CO HOSP AUTH DBA EASTMAN FAMILY PRACTICE LLC
  • Facility Address: 840 PROFESSIONAL CENTER DRIVE
    EASTMAN, GA
    ZIP 31023
  • Facility Phone: 478 374-7801
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: STEWART V. GRIZZARD
  • NPI Number: 1255948717
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2030008
LAB Type Rural Health Clinic
Facility Name DODGE CO HOSP AUTH DBA EASTMAN FAMILY PRACTICE LLC
Street 840 PROFESSIONAL CENTER DRIVE
City EASTMAN
State GA
ZIP 31023
Phone 478 374-7801
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/21/2024
Certificate Expiration Date 3/20/2026
Facility Type Rural Health Clinic
Lab Director STEWART V. GRIZZARD

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