11D2108686 CLIA NUMBER - CCSG, INC

Laboratory Demographics

CLIA Number: 11D2108686

Facility Name: CCSG, INC

Facility Address:
116 MIMOSA DRIVE
THOMASVILLE, GA
ZIP 31792
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Facility Phone Number: 229 551-0083

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1295120145

Taxonomy: 207RC0000X - Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

CLIA Record

Field Name	Field Value
CLIA Number	11D2108686
LAB Type	Physician Office
Facility Name	CCSG, INC
Street	116 MIMOSA DRIVE
City	THOMASVILLE
State	GA
ZIP	31792
Phone	229 551-0083
CertificateType	4
CertificateEffectiveDate	2/9/2024
CertificateExpirationDate	2/8/2026
FacilityType	Waiver

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