11D0258205 CLIA NUMBER - EAGLES LANDING OB/GYN ASSOCIATION

Laboratory Demographics

  • CLIA Code: 11D0258205
  • Facility Name: EAGLES LANDING OB/GYN ASSOCIATION
  • Facility Address: 330 JODECO ROAD, SUITE D
    MCDONOUGH, GA
    ZIP 30253
  • Facility Phone: 770 474-1919
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: SHOBHA C. RAO
  • NPI Number: 1649225517
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 11D0258205
LAB Type Physician Office
Facility Name EAGLES LANDING OB/GYN ASSOCIATION
Street 330 JODECO ROAD, SUITE D
City MCDONOUGH
State GA
ZIP 30253
Phone 770 474-1919
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director SHOBHA C. RAO

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