CLIA lab
CLIA 11D1101206: Extended Wellness LLC
Vidalia, GA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 11D1101206 belongs to Extended Wellness LLC in Vidalia, GA.
Certificate of Waiver, effective June 23, 2025, expires June 22, 2027.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- June 23, 2025
- Certificate expiration
- June 22, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- June 23, 2009
- Facility type
- Other
- Ownership (control type)
- Private
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 11D1101206
- Lab name
- Extended Wellness LLC
- Address
- 604 N Broadfoot Blvd, Vidalia, GA 30474
- Phone
- (678) 688-2196
- Fax
- (478) 274-8430
Annual test volume the lab reported
- Waived tests
- 150
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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Related
Questions
What is the CLIA number for Extended Wellness LLC in Vidalia?
11D1101206, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Extended Wellness LLC hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 11D1101206 expire?
The CMS file lists June 22, 2027 as the certificate expiration date; the certificate took effect June 23, 2025.