11D2257639 CLIA NUMBER - NEUROLOGY AND NEURODIAGNOSTIC LLC

Laboratory Demographics

CLIA Number: 11D2257639

Facility Name: NEUROLOGY AND NEURODIAGNOSTIC LLC

Facility Address:
114 HILL POND LANE
STATESBORO, GA
ZIP 30458
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Facility Phone Number: 912 486-1140

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1508393208

Taxonomy: 2084N0600X - Psychiatry & Neurology
Clinical Neurophysiology is a subspecialty with psychiatric or neurologic expertise in the diagnosis and management of central, peripheral, and autonomic nervous system disorders using combined clinical evaluation and electrophysiologic testing such as electroencephalography (EEG), electromyography (EMG), and nerve conduction studies (NCS).

CLIA Record

Field Name	Field Value
CLIA Number	11D2257639
LAB Type	Physician Office
Facility Name	NEUROLOGY AND NEURODIAGNOSTIC LLC
Street	114 HILL POND LANE
City	STATESBORO
State	GA
ZIP	30458
Phone	912 486-1140
CertificateType	4
CertificateEffectiveDate	4/8/2024
CertificateExpirationDate	4/7/2026
FacilityType	Waiver

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