42D0909801 CLIA NUMBER - FAMILY HEALTHCARE SAVANNAH LAKES A DIVISION OF SELF MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 42D0909801
  • Facility Name: FAMILY HEALTHCARE SAVANNAH LAKES A DIVISION OF SELF MEDICAL GROUP
  • Facility Address: 207 HOLIDAY ROAD
    MC CORMICK, SC
    ZIP 29835
  • Facility Phone: 864 725-5612
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JENNIFER JONES
  • NPI Number: 1992370654
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 42D0909801
LAB Type Physician Office
Facility Name FAMILY HEALTHCARE SAVANNAH LAKES A DIVISION OF SELF MEDICAL GROUP
Street 207 HOLIDAY ROAD
City MC CORMICK
State SC
ZIP 29835
Phone 864 725-5612
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 2/5/2024
Certificate Expiration Date 2/4/2026
Facility Type Physician Office
Lab Director JENNIFER JONES

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