11D2103317 CLIA NUMBER - IVYDALE AT WILLOW LODGE LLC

Laboratory Demographics

  • CLIA Code: 11D2103317
  • Facility Name: IVYDALE AT WILLOW LODGE LLC
  • Facility Address: 3120 S MAIN ST
    MOULTRIE, GA
    ZIP 31768
  • Facility Phone: 229 668-4721
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: GENI AKRIDGE
  • NPI Number: 1750766507
  • Taxonomy: 310400000X - Assisted Living Facility

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2103317
LAB Type Assisted Living Facility
Facility Name IVYDALE AT WILLOW LODGE LLC
Street 3120 S MAIN ST
City MOULTRIE
State GA
ZIP 31768
Phone 229 668-4721
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/9/2025
Certificate Expiration Date 10/8/2027
Facility Type Assisted Living Facility
Lab Director GENI AKRIDGE

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