11D2318405 CLIA NUMBER - SOUTH GEORGIA PHYSICIANS GROUP

Laboratory Demographics

  • CLIA Code: 11D2318405
  • Facility Name: SOUTH GEORGIA PHYSICIANS GROUP
  • Facility Address: 821 S MAIN STREET, SUITE A
    BAXLEY, GA
    ZIP 31513
  • Facility Phone: 912 705-2273
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHELLE LUSK
  • NPI Number: 1255570321
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2318405
LAB Type Physician Office
Facility Name SOUTH GEORGIA PHYSICIANS GROUP
Street 821 S MAIN STREET, SUITE A
City BAXLEY
State GA
ZIP 31513
Phone 912 705-2273
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/11/2025
Certificate Expiration Date 2/10/2027
Facility Type Physician Office
Lab Director MICHELLE LUSK

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