11D2247531 CLIA NUMBER - ALTAMAHA PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 11D2247531
  • Facility Name: ALTAMAHA PRIMARY CARE
  • Facility Address: 248 NE BROAD STREET
    JESUP, GA
    ZIP 31546
  • Facility Phone: 912 559-2696
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KIMBERLY A. KIRK
  • NPI Number: 1093472896
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 11D2247531
LAB Type Physician Office
Facility Name ALTAMAHA PRIMARY CARE
Street 248 NE BROAD STREET
City JESUP
State GA
ZIP 31546
Phone 912 559-2696
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/7/2024
Certificate Expiration Date 1/6/2026
Facility Type Physician Office
Lab Director KIMBERLY A. KIRK

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