11D2074716 CLIA NUMBER - MCC INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 11D2074716
  • Facility Name: MCC INTERNAL MEDICINE
  • Facility Address: 6501 PEAKE ROAD, SUITE 100
    MACON, GA
    ZIP 31210
  • Facility Phone: 478 273-2662
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEREMIAH R. MCCLURE
  • NPI Number: 1366899189
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 11D2074716
LAB Type Physician Office
Facility Name MCC INTERNAL MEDICINE
Street 6501 PEAKE ROAD, SUITE 100
City MACON
State GA
ZIP 31210
Phone 478 273-2662
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/9/2025
Certificate Expiration Date 3/8/2027
Facility Type Physician Office
Lab Director JEREMIAH R. MCCLURE

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