11D2316268 CLIA NUMBER - MAGNOLIA PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 11D2316268
  • Facility Name: MAGNOLIA PRIMARY CARE
  • Facility Address: 807 S LAUREL STREET, SUITE B
    SPRINGFIELD, GA
    ZIP 31329
  • Facility Phone: 912 812-1005
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LAUREN E. OGLESBY
  • NPI Number: 1093537193
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2316268
LAB Type Physician Office
Facility Name MAGNOLIA PRIMARY CARE
Street 807 S LAUREL STREET, SUITE B
City SPRINGFIELD
State GA
ZIP 31329
Phone 912 812-1005
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/2/2025
Certificate Expiration Date 1/1/2027
Facility Type Physician Office
Lab Director LAUREN E. OGLESBY

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