11D0264467 CLIA NUMBER - SOUTHSIDE OB/GYN

Laboratory Demographics

  • CLIA Code: 11D0264467
  • Facility Name: SOUTHSIDE OB/GYN
  • Facility Address: 10055 FORD AVENUE, SUITE 5 B
    RICHMOND HILL, GA
    ZIP 31324
  • Facility Phone: 912 756-3404
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: FRANCISCO A. DUENO
  • NPI Number: 1407024557
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 11D0264467
LAB Type Physician Office
Facility Name SOUTHSIDE OB/GYN
Street 10055 FORD AVENUE, SUITE 5 B
City RICHMOND HILL
State GA
ZIP 31324
Phone 912 756-3404
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 FRANCISCO A. DUENO

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