11D2194798 CLIA NUMBER - BAPTIST VILLAGE, INC DBA VILLAGE LAKE SUITES

Laboratory Demographics

  • CLIA Code: 11D2194798
  • Facility Name: BAPTIST VILLAGE, INC DBA VILLAGE LAKE SUITES
  • Facility Address: 715 VILLAGE LAKE DRIVE
    WAYCROSS, GA
    ZIP 31503
  • Facility Phone: 912 287-9977
  • Facility Type: Other - PERSONAL CARE HOME
  • Facility Type: Waiver
  • Lab Director: HIEDI MOODY
  • NPI Number: 1548242837
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D2194798
LAB Type Other - PERSONAL CARE HOME
Facility Name BAPTIST VILLAGE, INC DBA VILLAGE LAKE SUITES
Street 715 VILLAGE LAKE DRIVE
City WAYCROSS
State GA
ZIP 31503
Phone 912 287-9977
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/2/2024
Certificate Expiration Date 10/1/2026
Facility Type Other - PERSONAL CARE HOME
Lab Director HIEDI MOODY

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