11D2312907 CLIA NUMBER - SOUTHWELL GASTROENTEROLOGY

Laboratory Demographics

  • CLIA Code: 11D2312907
  • Facility Name: SOUTHWELL GASTROENTEROLOGY
  • Facility Address: 2922 N OAK STREET, SUITE C
    VALDOSTA, GA
    ZIP 31602
  • Facility Phone: 229 353-6121
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ERIC WARD
  • NPI Number: 1497330625
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2312907
LAB Type Physician Office
Facility Name SOUTHWELL GASTROENTEROLOGY
Street 2922 N OAK STREET, SUITE C
City VALDOSTA
State GA
ZIP 31602
Phone 229 353-6121
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/22/2024
Certificate Expiration Date 10/21/2026
Facility Type Physician Office
Lab Director ERIC WARD

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