CLIA lab
CLIA 11D2122192: Ga South Family Medicine Residency Clinic
Moultrie, GA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 11D2122192 belongs to Ga South Family Medicine Residency Clinic in Moultrie, GA.
Certificate of Waiver, effective September 26, 2025, expires September 25, 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
- September 26, 2025
- Certificate expiration
- September 25, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- November 22, 2016
- Facility type
- Physician office
- Ownership (control type)
- Government, county
- 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
- 11D2122192
- Lab name
- Ga South Family Medicine Residency Clinic
- Address
- 3131 S Main Street, Bldg J, Moultrie, GA 31768
- Phone
- (229) 502-9769
- Fax
- (229) 985-3751
Annual test volume the lab reported
- Waived tests
- 6,500
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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- Careconnect PediatricsCertificate of Waiver, Federally qualified health center11D2153051
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- Ccsg IncCertificate of Waiver, Physician office11D2224496
- Chancy Drugs MoultireCertificate of Waiver, Pharmacy11D2184893
- Colquit Regional Diaylsis HomeCertificate of Waiver, End stage renal disease dialysis facility11D2329957
- Colquitt Co Board of EducationCertificate of Waiver, School or student health service11D2135673
- Colquitt County EMSCertificate of Waiver, Ambulance11D2199858
- Colquitt County JailCertificate of Waiver, Prison11D2292378
- Colquitt Regional Community ParamedicineCertificate of Waiver, Other11D2277986
Related
Questions
What is the CLIA number for Ga South Family Medicine Residency Clinic in Moultrie?
11D2122192, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Ga South Family Medicine Residency Clinic hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 11D2122192 expire?
The CMS file lists September 25, 2027 as the certificate expiration date; the certificate took effect September 26, 2025.