11D2065958 CLIA NUMBER - MACON VASCULAR CARE, LLC

Laboratory Demographics

  • CLIA Code: 11D2065958
  • Facility Name: MACON VASCULAR CARE, LLC
  • Facility Address: 889 2ND STREET
    MACON, GA
    ZIP 31201
  • Facility Phone: 239 597-2010
  • Facility Type: Other - EXT OF PHYSICIAN OFFICE
  • Facility Type: Waiver
  • Lab Director: DR. DEMETRIOUS BLACKMON
  • NPI Number: 1417381781
  • Taxonomy: 2086S0129X - Surgery

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2065958
LAB Type Other - EXT OF PHYSICIAN OFFICE
Facility Name MACON VASCULAR CARE, LLC
Street 889 2ND STREET
City MACON
State GA
ZIP 31201
Phone 239 597-2010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/18/2025
Certificate Expiration Date 9/17/2027
Facility Type Other - EXT OF PHYSICIAN OFFICE
Lab Director DR. DEMETRIOUS BLACKMON

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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