11D2074716 CLIA NUMBER - MCC INTERNAL MEDICINE

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Laboratory Demographics

CLIA Number: 11D2074716

Facility Name: MCC INTERNAL MEDICINE

Facility Address:
6501 PEAKE ROAD, SUITE 100
MACON, GA
ZIP 31210
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Facility Phone Number: 478 273-2662

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1366899189

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

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
CertificateType	4
CertificateEffectiveDate	3/9/2023
CertificateExpirationDate	3/8/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024