11D2256938 CLIA NUMBER - TIFTAREA PEDIATRICS

Laboratory Demographics

  • CLIA Code: 11D2256938
  • Facility Name: TIFTAREA PEDIATRICS
  • Facility Address: 215 WEST 12TH STREET
    TIFTON, GA
    ZIP 31794
  • Facility Phone: 229 396-5335
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARK WILSON
  • NPI Number: 1154081271
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D2256938
LAB Type Physician Office
Facility Name TIFTAREA PEDIATRICS
Street 215 WEST 12TH STREET
City TIFTON
State GA
ZIP 31794
Phone 229 396-5335
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/30/2024
Certificate Expiration Date 3/29/2026
Facility Type Physician Office
Lab Director MARK WILSON

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