11D0261690 CLIA NUMBER - NORTHEAST GEORGIA PHYSICIANS GROUP LAVONIA CLINIC

Laboratory Demographics

  • CLIA Code: 11D0261690
  • Facility Name: NORTHEAST GEORGIA PHYSICIANS GROUP LAVONIA CLINIC
  • Facility Address: 12192 AUGUSTA ROAD
    LAVONIA, GA
    ZIP 30553
  • Facility Phone: 706 356-1072
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: JONATHAN HALL
  • NPI Number: 1710965900
  • Taxonomy: 261QP3300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0261690
LAB Type Physician Office
Facility Name NORTHEAST GEORGIA PHYSICIANS GROUP LAVONIA CLINIC
Street 12192 AUGUSTA ROAD
City LAVONIA
State GA
ZIP 30553
Phone 706 356-1072
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 5/8/2025
Certificate Expiration Date 5/7/2027
Facility Type Physician Office
Lab Director JONATHAN HALL

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