11D2199302 CLIA NUMBER - SOUTHWELL OB/GYN

Laboratory Demographics

  • CLIA Code: 11D2199302
  • Facility Name: SOUTHWELL OB/GYN
  • Facility Address: 814 NORTHWOOD PARK DRIVE
    VALDOSTA, GA
    ZIP 31602
  • Facility Phone: 229 353-6121
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOE C. CLIFTON
  • NPI Number: 1962035360
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D2199302
LAB Type Physician Office
Facility Name SOUTHWELL OB/GYN
Street 814 NORTHWOOD PARK DRIVE
City VALDOSTA
State GA
ZIP 31602
Phone 229 353-6121
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/6/2024
Certificate Expiration Date 11/5/2026
Facility Type Physician Office
Lab Director JOE C. CLIFTON

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