11D2118853 CLIA NUMBER - HENDERSON FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 11D2118853
  • Facility Name: HENDERSON FAMILY PRACTICE
  • Facility Address: 624 TEBEAU STREET
    WAYCROSS, GA
    ZIP 31501
  • Facility Phone: 912 809-6052
  • Facility Type: Practitioner Other
  • Facility Type: Microscopy
  • Lab Director: LORI HENDERSON
  • NPI Number: 1629522032
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2118853
LAB Type Practitioner Other
Facility Name HENDERSON FAMILY PRACTICE
Street 624 TEBEAU STREET
City WAYCROSS
State GA
ZIP 31501
Phone 912 809-6052
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/15/2024
Certificate Expiration Date 9/14/2026
Facility Type Practitioner Other
Lab Director LORI HENDERSON

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