11D2083108 CLIA NUMBER - JESUP PEDIATRICS, PC

Laboratory Demographics

  • CLIA Code: 11D2083108
  • Facility Name: JESUP PEDIATRICS, PC
  • Facility Address: 176 MEMORIAL DRIVE
    JESUP, GA
    ZIP 31545
  • Facility Phone: 912 427-9378
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PLATON J. COLLIPP
  • NPI Number: 1316078538
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D2083108
LAB Type Physician Office
Facility Name JESUP PEDIATRICS, PC
Street 176 MEMORIAL DRIVE
City JESUP
State GA
ZIP 31545
Phone 912 427-9378
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/28/2024
Certificate Expiration Date 8/27/2026
Facility Type Physician Office
Lab Director PLATON J. COLLIPP

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