11D2259716 CLIA NUMBER - VIDALIA IMMEDIATE AND PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 11D2259716
  • Facility Name: VIDALIA IMMEDIATE AND PRIMARY CARE
  • Facility Address: 122 ALICE COLEMAN DRIVE
    VIDALIA, GA
    ZIP 30474
  • Facility Phone: 912 805-2273
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DEWEY HOWELL
  • NPI Number: 1942974167
  • Taxonomy: 261QP2300X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2259716
LAB Type Physician Office
Facility Name VIDALIA IMMEDIATE AND PRIMARY CARE
Street 122 ALICE COLEMAN DRIVE
City VIDALIA
State GA
ZIP 30474
Phone 912 805-2273
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/10/2024
Certificate Expiration Date 5/9/2026
Facility Type Physician Office
Lab Director DEWEY HOWELL

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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