11D2060574 CLIA NUMBER - SUPREME INTERNAL MEDICINE, PC

Laboratory Demographics

  • CLIA Code: 11D2060574
  • Facility Name: SUPREME INTERNAL MEDICINE, PC
  • Facility Address: 1207 MERCHANT WAY, SUITE 201
    STATESBORO, GA
    ZIP 30458
  • Facility Phone: 912 243-9080
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. HAMILTON EMOKPAE
  • NPI Number: 1891130647
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2060574
LAB Type Physician Office
Facility Name SUPREME INTERNAL MEDICINE, PC
Street 1207 MERCHANT WAY, SUITE 201
City STATESBORO
State GA
ZIP 30458
Phone 912 243-9080
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/13/2025
Certificate Expiration Date 6/12/2027
Facility Type Physician Office
Lab Director DR. HAMILTON EMOKPAE

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