11D2170255 CLIA NUMBER - SUMMERVILLE OCCUPATIONAL NURSE OFFICE

Laboratory Demographics

  • CLIA Code: 11D2170255
  • Facility Name: SUMMERVILLE OCCUPATIONAL NURSE OFFICE
  • Facility Address: 106 JOHN BANKSTON DRIVE
    SUMMERVILLE, GA
    ZIP 30747
  • Facility Phone: 480 868-0646
  • Facility Type: Other - OUT PATIENT
  • Facility Type: Waiver
  • Lab Director: CANDY FULMER
  • NPI Number: 1336339076
  • Taxonomy: 111N00000X - Chiropractor

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2170255
LAB Type Other - OUT PATIENT
Facility Name SUMMERVILLE OCCUPATIONAL NURSE OFFICE
Street 106 JOHN BANKSTON DRIVE
City SUMMERVILLE
State GA
ZIP 30747
Phone 480 868-0646
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/7/2025
Certificate Expiration Date 8/6/2027
Facility Type Other - OUT PATIENT
Lab Director CANDY FULMER

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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