11D2099096 CLIA NUMBER - PRIMARY CARE OF SOUTHWEST GEORGIA-BAINBRIDGE

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Laboratory Demographics

CLIA Number: 11D2099096

Facility Name: PRIMARY CARE OF SOUTHWEST GEORGIA-BAINBRIDGE

Facility Address:
509 WHEAT AVENUE
BAINBRIDGE, GA
ZIP 39819
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Facility Phone Number: 229 415-4421

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1033212634

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	11D2099096
LAB Type	Federally Qualified Health Center
Facility Name	PRIMARY CARE OF SOUTHWEST GEORGIA-BAINBRIDGE
Street	509 WHEAT AVENUE
City	BAINBRIDGE
State	GA
ZIP	39819
Phone	229 415-4421
CertificateType	4
CertificateEffectiveDate	7/21/2023
CertificateExpirationDate	7/20/2025
FacilityType	Waiver

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