11D2287774 CLIA NUMBER - COASTAL COMMUNITY HEALTH

Laboratory Demographics

  • CLIA Code: 11D2287774
  • Facility Name: COASTAL COMMUNITY HEALTH
  • Facility Address: 4261 ALTAMA AVENUE
    BRUNSWICK, GA
    ZIP 31520
  • Facility Phone: 912 289-2006
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: BRIANA GRAY
  • NPI Number: 1972223162
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2287774
LAB Type Federally Qualified Health Center
Facility Name COASTAL COMMUNITY HEALTH
Street 4261 ALTAMA AVENUE
City BRUNSWICK
State GA
ZIP 31520
Phone 912 289-2006
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 8/17/2023
Certificate Expiration Date 8/16/2025
Facility Type Federally Qualified Health Center
Lab Director BRIANA GRAY

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