11D2066736 CLIA NUMBER - APPLECARE KINGSLAND

Laboratory Demographics

  • CLIA Code: 11D2066736
  • Facility Name: APPLECARE KINGSLAND
  • Facility Address: 1481 GA - 40
    KINGSLAND, GA
    ZIP 31548
  • Facility Phone: 912 576-6865
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JACK MELVIN DEESE JR
  • NPI Number: 1619398187
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2066736
LAB Type Physician Office
Facility Name APPLECARE KINGSLAND
Street 1481 GA - 40
City KINGSLAND
State GA
ZIP 31548
Phone 912 576-6865
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/3/2023
Certificate Expiration Date 10/2/2025
Facility Type Physician Office
Lab Director JACK MELVIN DEESE JR

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