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

Laboratory Demographics

CLIA Number: 11D2044574

Facility Name: MISTY D POOLE, MD, LLC

Facility Address:
210 MOSE COLEMAN DRIVE
VIDALIA, GA
ZIP 30474
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Facility Phone Number: 912 537-2260

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1134358419

Taxonomy: 207R00000X - Internal Medicine
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

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 912 537-2260
CertificateType 4
CertificateEffectiveDate 7/26/2022
CertificateExpirationDate 7/25/2024
FacilityType Waiver

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