11D2214854 CLIA NUMBER - WAYNE SJC MEDICAL GROUP - OBGYN

Laboratory Demographics

  • CLIA Code: 11D2214854
  • Facility Name: WAYNE SJC MEDICAL GROUP - OBGYN
  • Facility Address: 228 MEMORIAL DRIVE
    JESUP, GA
    ZIP 31545
  • Facility Phone: 912 559-2432
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: OGOCHUKWU OKPALA
  • NPI Number: 1538421177
  • Taxonomy: 207Y00000X - Otolaryngology

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CLIA Record

Field Name Field Value
CLIA Number 11D2214854
LAB Type Physician Office
Facility Name WAYNE SJC MEDICAL GROUP - OBGYN
Street 228 MEMORIAL DRIVE
City JESUP
State GA
ZIP 31545
Phone 912 559-2432
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 2/25/2025
Certificate Expiration Date 2/24/2027
Facility Type Physician Office
Lab Director OGOCHUKWU OKPALA

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