11D2107683 CLIA NUMBER - CLARK MEDICAL GROUP, LLC

Laboratory Demographics

CLIA Number: 11D2107683

Facility Name: CLARK MEDICAL GROUP, LLC

Facility Address:
117 HILL POND LANE
STATESBORO, GA
ZIP 30458
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Facility Phone Number: 912 623-2155

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1477927192

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	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
CertificateType	4
CertificateEffectiveDate	1/20/2024
CertificateExpirationDate	1/19/2026
FacilityType	Waiver

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