11D2155759 CLIA NUMBER - LANEY INTERNAL MEDICINE GROUP

Laboratory Demographics

CLIA Number: 11D2155759

Facility Name: LANEY INTERNAL MEDICINE GROUP

Facility Address:
209 S TALLAHASSEE STREET
HAZLEHURST, GA
ZIP 31539
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Facility Phone Number: 912 375-3095

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1891270393

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2155759
LAB Type	Physician Office
Facility Name	LANEY INTERNAL MEDICINE GROUP
Street	209 S TALLAHASSEE STREET
City	HAZLEHURST
State	GA
ZIP	31539
Phone	912 375-3095
CertificateType	4
CertificateEffectiveDate	10/4/2022
CertificateExpirationDate	10/3/2024
FacilityType	Waiver

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