11D2315718 CLIA NUMBER - HOMETOWN PHYSICIAN GROUP, LLC

Laboratory Demographics

  • CLIA Code: 11D2315718
  • Facility Name: HOMETOWN PHYSICIAN GROUP, LLC
  • Facility Address: 1399 LAFAYETTE PARKWAY
    LAGRANGE, GA
    ZIP 30240
  • Facility Phone: 706 298-4937
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CLIFFORD TUMAMBING
  • NPI Number: 1992153548
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2315718
LAB Type Physician Office
Facility Name HOMETOWN PHYSICIAN GROUP, LLC
Street 1399 LAFAYETTE PARKWAY
City LAGRANGE
State GA
ZIP 30240
Phone 706 298-4937
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/18/2024
Certificate Expiration Date 12/17/2026
Facility Type Physician Office
Lab Director CLIFFORD TUMAMBING

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