11D2069400 CLIA NUMBER - ERGENT MED 1

Laboratory Demographics

  • CLIA Code: 11D2069400
  • Facility Name: ERGENT MED 1
  • Facility Address: 5248 NEW JESUP HIGHWAY
    BRUNSWICK, GA
    ZIP 31523
  • Facility Phone: 912 264-1883
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL K. HAMM
  • NPI Number: 1700285418
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2069400
LAB Type Physician Office
Facility Name ERGENT MED 1
Street 5248 NEW JESUP HIGHWAY
City BRUNSWICK
State GA
ZIP 31523
Phone 912 264-1883
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/25/2023
Certificate Expiration Date 11/24/2025
Facility Type Physician Office
Lab Director MICHAEL K. HAMM

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