11D2094450 CLIA NUMBER - MAMA DOC PEDIATRICS

Laboratory Demographics

  • CLIA Code: 11D2094450
  • Facility Name: MAMA DOC PEDIATRICS
  • Facility Address: 4451 COUNTRY CLUB ROAD SUITE B
    STATESBORO, GA
    ZIP 30458
  • Facility Phone: 912 871-5437
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANNA H. BENSON
  • NPI Number: 1477009181
  • Taxonomy: 208000000X - Pediatrics

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2094450
LAB Type Physician Office
Facility Name MAMA DOC PEDIATRICS
Street 4451 COUNTRY CLUB ROAD SUITE B
City STATESBORO
State GA
ZIP 30458
Phone 912 871-5437
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/17/2025
Certificate Expiration Date 4/16/2027
Facility Type Physician Office
Lab Director ANNA H. BENSON

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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