11D2107683 CLIA NUMBER - CLARK MEDICAL GROUP, LLC

Laboratory Demographics

  • CLIA Code: 11D2107683
  • Facility Name: CLARK MEDICAL GROUP, LLC
  • Facility Address: 117 HILL POND LANE
    STATESBORO, GA
    ZIP 30458
  • Facility Phone: 912 623-2155
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LISA M. WHITE
  • NPI Number: 1477927192
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2107683
LAB Type Physician Office
Facility Name CLARK MEDICAL GROUP, LLC
Street 117 HILL POND LANE
City STATESBORO
State GA
ZIP 30458
Phone 912 623-2155
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/20/2024
Certificate Expiration Date 1/19/2026
Facility Type Physician Office
Lab Director LISA M. WHITE

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