11D2232392 CLIA NUMBER - SOUTH CENTRAL FAMILY HEALTH CARE

Laboratory Demographics

CLIA Number: 11D2232392

Facility Name: SOUTH CENTRAL FAMILY HEALTH CARE

Facility Address:
607 C NORTH IRWIN AVENUE
OCILLA, GA
ZIP 31774
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Facility Phone Number: 229 468-5020

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1356709646

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2232392
LAB Type	Federally Qualified Health Center
Facility Name	SOUTH CENTRAL FAMILY HEALTH CARE
Street	607 C NORTH IRWIN AVENUE
City	OCILLA
State	GA
ZIP	31774
Phone	229 468-5020
CertificateType	4
CertificateEffectiveDate	8/12/2023
CertificateExpirationDate	8/11/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024