11D2238043 CLIA NUMBER - PRIMARY CARE OF SOUTHWEST GEORGIA EARLY COUNTY ELEMENTARY SCHOOL

Laboratory Demographics

CLIA Number: 11D2238043

Facility Name: PRIMARY CARE OF SOUTHWEST GEORGIA EARLY COUNTY ELEMENTARY SCHOOL

Facility Address:
283 MARTIN LUTHER KING JR BOULEVARD
BLAKELY, GA
ZIP 39823
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Facility Phone Number: 229 584-2540

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1932877610

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2238043
LAB Type	Federally Qualified Health Center
Facility Name	PRIMARY CARE OF SOUTHWEST GEORGIA EARLY COUNTY ELEMENTARY SCHOOL
Street	283 MARTIN LUTHER KING JR BOULEVARD
City	BLAKELY
State	GA
ZIP	39823
Phone	229 584-2540
CertificateType	4
CertificateEffectiveDate	9/30/2023
CertificateExpirationDate	9/29/2025
FacilityType	Waiver

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