11D0939813 CLIA NUMBER - STATESBORO CARDIOLOGY PC

Laboratory Demographics

  • CLIA Code: 11D0939813
  • Facility Name: STATESBORO CARDIOLOGY PC
  • Facility Address: 5 GRADY JOHNSON ROAD
    STATESBORO, GA
    ZIP 30458
  • Facility Phone: 912 489-6246
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STANLEY J. SHIN
  • NPI Number: 1205840105
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0939813
LAB Type Physician Office
Facility Name STATESBORO CARDIOLOGY PC
Street 5 GRADY JOHNSON ROAD
City STATESBORO
State GA
ZIP 30458
Phone 912 489-6246
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/2/2024
Certificate Expiration Date 2/1/2026
Facility Type Physician Office
Lab Director STANLEY J. SHIN

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