11D2133713 CLIA NUMBER - NICHOLLS FAMILY HEALTHCARE

Laboratory Demographics

  • CLIA Code: 11D2133713
  • Facility Name: NICHOLLS FAMILY HEALTHCARE
  • Facility Address: 1205 VAN STREET HIGHWAY
    NICHOLLS, GA
    ZIP 31554
  • Facility Phone: 912 345-2473
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: IAN FURTADO
  • NPI Number: 1669418711
  • Taxonomy: 251K00000X - Public Health or Welfare

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CLIA Record

Field Name Field Value
CLIA Number 11D2133713
LAB Type Rural Health Clinic
Facility Name NICHOLLS FAMILY HEALTHCARE
Street 1205 VAN STREET HIGHWAY
City NICHOLLS
State GA
ZIP 31554
Phone 912 345-2473
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/19/2025
Certificate Expiration Date 7/18/2027
Facility Type Rural Health Clinic
Lab Director IAN FURTADO

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