11D2276140 CLIA NUMBER - PREMIERE HEALTH & WELLNESS

Laboratory Demographics

CLIA Number: 11D2276140

Facility Name: PREMIERE HEALTH & WELLNESS

Facility Address:
1710 1/2 ALICE STREET
WAYCROSS, GA
ZIP 31501
Get Directions

Facility Phone Number: 912 809-2341

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1316658990

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	11D2276140
LAB Type	Physician Office
Facility Name	PREMIERE HEALTH & WELLNESS
Street	1710 1/2 ALICE STREET
City	WAYCROSS
State	GA
ZIP	31501
Phone	912 809-2341
CertificateType	4
CertificateEffectiveDate	2/3/2023
CertificateExpirationDate	2/2/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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