11D2326797 CLIA NUMBER - SOUTHERN ROOTS DPC, LLC

Laboratory Demographics

  • CLIA Code: 11D2326797
  • Facility Name: SOUTHERN ROOTS DPC, LLC
  • Facility Address: 407 NORTH PARRISH AVENUE
    ADEL, GA
    ZIP 31620
  • Facility Phone: 229 300-3642
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUMMER B. ALVAREZ
  • NPI Number: 1710870944
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 11D2326797
LAB Type Physician Office
Facility Name SOUTHERN ROOTS DPC, LLC
Street 407 NORTH PARRISH AVENUE
City ADEL
State GA
ZIP 31620
Phone 229 300-3642
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/10/2025
Certificate Expiration Date 7/9/2027
Facility Type Physician Office
Lab Director SUMMER B. ALVAREZ

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