11D2285173 CLIA NUMBER - BULLOCH FAMILY PRACTICE LLC

Laboratory Demographics

  • CLIA Code: 11D2285173
  • Facility Name: BULLOCH FAMILY PRACTICE LLC
  • Facility Address: 112 HILL POND LANE
    STATESBORO, GA
    ZIP 30458
  • Facility Phone: 912 237-9228
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LOY D. COWART III
  • NPI Number: 1477239218
  • Taxonomy: 207Q00000X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2285173
LAB Type Physician Office
Facility Name BULLOCH FAMILY PRACTICE LLC
Street 112 HILL POND LANE
City STATESBORO
State GA
ZIP 30458
Phone 912 237-9228
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/7/2025
Certificate Expiration Date 7/6/2027
Facility Type Physician Office
Lab Director LOY D. COWART III

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