11D0264179 CLIA NUMBER - MACON GYN OB ASSOCIATES PA

Laboratory Demographics

  • CLIA Code: 11D0264179
  • Facility Name: MACON GYN OB ASSOCIATES PA
  • Facility Address: 650 COLISEUM PLACE
    MACON, GA
    ZIP 31217
  • Facility Phone: 478 745-7935
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: A TAYLOR COPPAGE III MD
  • NPI Number: 1073629630
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 11D0264179
LAB Type Physician Office
Facility Name MACON GYN OB ASSOCIATES PA
Street 650 COLISEUM PLACE
City MACON
State GA
ZIP 31217
Phone 478 745-7935
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 1/1/2024
Certificate Expiration Date 12/31/2025
Facility Type Physician Office
Lab Director A TAYLOR COPPAGE III MD

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