42D2180678 CLIA NUMBER - GEORGETOWN PHYSICIAN ASSOCIATES, LLC DBA TIDELANDS HEALTH FAMILY MEDICINE PAWLEYS ISLAND

Laboratory Demographics

  • CLIA Code: 42D2180678
  • Facility Name: GEORGETOWN PHYSICIAN ASSOCIATES, LLC DBA TIDELANDS HEALTH FAMILY MEDICINE PAWLEYS ISLAND
  • Facility Address: 9699 OCEAN HWY
    PAWLEYS ISLAND, SC
    ZIP 29585
  • Facility Phone: 843 237-4296
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KENNETH A. MATTOX
  • NPI Number: 1952343766
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 42D2180678
LAB Type Physician Office
Facility Name GEORGETOWN PHYSICIAN ASSOCIATES, LLC DBA TIDELANDS HEALTH FAMILY MEDICINE PAWLEYS ISLAND
Street 9699 OCEAN HWY
City PAWLEYS ISLAND
State SC
ZIP 29585
Phone 843 237-4296
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/18/2024
Certificate Expiration Date 3/17/2026
Facility Type Physician Office
Lab Director KENNETH A. MATTOX

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This page was last updated on: 3/20/2025