11D0264002 CLIA NUMBER - MANMOHAN GUPTA MD

Laboratory Demographics

  • CLIA Code: 11D0264002
  • Facility Name: MANMOHAN GUPTA MD
  • Facility Address: 770 PINE STREET SUITE 440
    MACON, GA
    ZIP 31201
  • Facility Phone: 912 741-4588
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MANMOHAN GUPTA
  • NPI Number: 1881960383
  • Taxonomy: 207RR0500X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0264002
LAB Type Physician Office
Facility Name MANMOHAN GUPTA MD
Street 770 PINE STREET SUITE 440
City MACON
State GA
ZIP 31201
Phone 912 741-4588
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 12/10/2024
Certificate Expiration Date 12/9/2026
Facility Type Physician Office
Lab Director MANMOHAN GUPTA

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