11D2284062 CLIA NUMBER - INTERSTATE HEALTH SYSTEMS INC

Laboratory Demographics

  • CLIA Code: 11D2284062
  • Facility Name: INTERSTATE HEALTH SYSTEMS INC
  • Facility Address: 5712 HIGHWAY 21, SUITE 300
    PORT WENTWORTH, GA
    ZIP 31407
  • Facility Phone: 931 526-1604
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TONEY HUDSON
  • NPI Number: 1073216990
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2284062
LAB Type Physician Office
Facility Name INTERSTATE HEALTH SYSTEMS INC
Street 5712 HIGHWAY 21, SUITE 300
City PORT WENTWORTH
State GA
ZIP 31407
Phone 931 526-1604
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/16/2025
Certificate Expiration Date 6/15/2027
Facility Type Physician Office
Lab Director TONEY HUDSON

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