11D0891563 CLIA NUMBER - GEORGIA UROLOGY PA JASPER

Laboratory Demographics

  • CLIA Code: 11D0891563
  • Facility Name: GEORGIA UROLOGY PA JASPER
  • Facility Address: 220 J L WHITE DRIVE, SUITE 201
    JASPER, GA
    ZIP 30143
  • Facility Phone: 706 692-4384
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JOEL A. ROSENFELD
  • NPI Number: 1235354424
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 11D0891563
LAB Type Physician Office
Facility Name GEORGIA UROLOGY PA JASPER
Street 220 J L WHITE DRIVE, SUITE 201
City JASPER
State GA
ZIP 30143
Phone 706 692-4384
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 9/12/2024
Certificate Expiration Date 9/11/2026
Facility Type Physician Office
Lab Director JOEL A. ROSENFELD

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