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11D2107161 CLIA NUMBER - MEDICAL OUTREACH SERVICESOF MADISON PC

Laboratory Demographics

CLIA Number: 11D2107161

Facility Name: MEDICAL OUTREACH SERVICESOF MADISON PC

Facility Address:
1075 SOUTH MAIN STREET SUITE 400
MADISON, GA
ZIP 30650
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Facility Phone Number: 706 342-9664

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1972975886

Taxonomy: 207R00000X - Internal Medicine
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

CLIA Record

Field Name Field Value
CLIA Number 11D2107161
LAB Type Physician Office
Facility Name MEDICAL OUTREACH SERVICESOF MADISON PC
Street 1075 SOUTH MAIN STREET SUITE 400
City MADISON
State GA
ZIP 30650
Phone 706 342-9664
CertificateType 4
CertificateEffectiveDate 1/7/2024
CertificateExpirationDate 1/6/2026
FacilityType Waiver

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