11D2260310 CLIA NUMBER - SOUTHERN CORRECTIONAL MEDICINE, LLC

Laboratory Demographics

CLIA Number: 11D2260310

Facility Name: SOUTHERN CORRECTIONAL MEDICINE, LLC

Facility Address:
921 SMITH AVENUE
THOMASVILLE, GA
ZIP 31792
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Facility Phone Number: 912 283-5260

Facility Type: Other - COUNTY JAIL

Certificate Type: Waiver

NPI Number: 1922266014

Taxonomy: 103TF0200X - Psychologist
A psychologist whose specialty is characterized by activities primarily intended to provide professional psychological expertise within the judicial and legal systems.

CLIA Record

Field Name	Field Value
CLIA Number	11D2260310
LAB Type	Other - COUNTY JAIL
Facility Name	SOUTHERN CORRECTIONAL MEDICINE, LLC
Street	921 SMITH AVENUE
City	THOMASVILLE
State	GA
ZIP	31792
Phone	912 283-5260
CertificateType	4
CertificateEffectiveDate	5/17/2022
CertificateExpirationDate	5/16/2024
FacilityType	Waiver

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