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

Laboratory Demographics

  • CLIA Code: 11D2099096
  • Facility Name: PRIMARY CARE OF SOUTHWEST GEORGIA-BAINBRIDGE
  • Facility Address: 509 WHEAT AVENUE
    BAINBRIDGE, GA
    ZIP 39819
  • Facility Phone: 229 415-4421
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: MURALI YELUGAPURI
  • NPI Number: 1033212634
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/21/2025
Certificate Expiration Date 7/20/2027
Facility Type Federally Qualified Health Center
Lab Director MURALI YELUGAPURI

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