11D2062439 CLIA NUMBER - FRONTLINE INTERNAL MEDICINE, LLC

Laboratory Demographics

  • CLIA Code: 11D2062439
  • Facility Name: FRONTLINE INTERNAL MEDICINE, LLC
  • Facility Address: 6 LESTER ROAD
    STATESBORO, GA
    ZIP 30458
  • Facility Phone: 912 687-8999
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: OGECHI H. MBAKWE
  • NPI Number: 1710328331
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2062439
LAB Type Physician Office
Facility Name FRONTLINE INTERNAL MEDICINE, LLC
Street 6 LESTER ROAD
City STATESBORO
State GA
ZIP 30458
Phone 912 687-8999
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/17/2025
Certificate Expiration Date 7/16/2027
Facility Type Physician Office
Lab Director OGECHI H. MBAKWE

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