11D2247531 CLIA NUMBER - ALTAMAHA PRIMARY CARE

Laboratory Demographics

CLIA Number: 11D2247531

Facility Name: ALTAMAHA PRIMARY CARE

Facility Address:
248 NE BROAD STREET
JESUP, GA
ZIP 31546
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Facility Phone Number: 912 559-2696

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1093472896

Taxonomy: 363LP2300X - Nurse Practitioner

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
CertificateType	4
CertificateEffectiveDate	1/7/2024
CertificateExpirationDate	1/6/2026
FacilityType	Waiver

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