11D2044574 CLIA NUMBER - MISTY D POOLE, MD, LLC

Laboratory Demographics

  • CLIA Code: 11D2044574
  • Facility Name: MISTY D POOLE, MD, LLC
  • Facility Address: 210 MOSE COLEMAN DRIVE
    VIDALIA, GA
    ZIP 30474
  • Facility Phone: 912 537-2200
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MISTY D. POOLE
  • NPI Number: 1134358419
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2044574
LAB Type Physician Office
Facility Name MISTY D POOLE, MD, LLC
Street 210 MOSE COLEMAN DRIVE
City VIDALIA
State GA
ZIP 30474
Phone 912 537-2200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/26/2024
Certificate Expiration Date 7/25/2026
Facility Type Physician Office
Lab Director DR. MISTY D. POOLE

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