11D2180730 CLIA NUMBER - SOUTHEAST GEORGIA HEALTH SERVICES, LLC

Laboratory Demographics

  • CLIA Code: 11D2180730
  • Facility Name: SOUTHEAST GEORGIA HEALTH SERVICES, LLC
  • Facility Address: 2004 PIONEER STREET
    WAYCROSS, GA
    ZIP 31501
  • Facility Phone: 912 338-6504
  • Facility Type: Other - WOUND CARE CLINIC
  • Facility Type: Waiver
  • Lab Director: JAMES H. BLOODWORTH
  • NPI Number: 1457613192
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2180730
LAB Type Other - WOUND CARE CLINIC
Facility Name SOUTHEAST GEORGIA HEALTH SERVICES, LLC
Street 2004 PIONEER STREET
City WAYCROSS
State GA
ZIP 31501
Phone 912 338-6504
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/19/2024
Certificate Expiration Date 3/18/2026
Facility Type Other - WOUND CARE CLINIC
Lab Director JAMES H. BLOODWORTH

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