11D2297733 CLIA NUMBER - OPTIM MEDICAL CENTER TATTNALL - BAXLEY

Laboratory Demographics

CLIA Number: 11D2297733

Facility Name: OPTIM MEDICAL CENTER TATTNALL - BAXLEY

Facility Address:
821 S MAIN STREET
BAXLEY, GA
ZIP 31513
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Facility Phone Number: 912 705-8040

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1588103592

Taxonomy: 2081P2900X - Physical Medicine & Rehabilitation
A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists.

CLIA Record

Field Name	Field Value
CLIA Number	11D2297733
LAB Type	Physician Office
Facility Name	OPTIM MEDICAL CENTER TATTNALL - BAXLEY
Street	821 S MAIN STREET
City	BAXLEY
State	GA
ZIP	31513
Phone	912 705-8040
CertificateType	4
CertificateEffectiveDate	1/22/2024
CertificateExpirationDate	1/21/2026
FacilityType	Waiver

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