11D0961485 CLIA NUMBER - SOUTHERN GASTROENTEROLOGY & HEPATOLOGY CONSULTANTS INC

Laboratory Demographics

  • CLIA Code: 11D0961485
  • Facility Name: SOUTHERN GASTROENTEROLOGY & HEPATOLOGY CONSULTANTS INC
  • Facility Address: 300 SHIRLEY AVENUE
    DOUGLAS, GA
    ZIP 31533
  • Facility Phone: 912 384-7275
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUDHAKAR JONNALAGADDA
  • NPI Number: 1336320761
  • Taxonomy: 207RG0100X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0961485
LAB Type Physician Office
Facility Name SOUTHERN GASTROENTEROLOGY & HEPATOLOGY CONSULTANTS INC
Street 300 SHIRLEY AVENUE
City DOUGLAS
State GA
ZIP 31533
Phone 912 384-7275
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/9/2025
Certificate Expiration Date 6/8/2027
Facility Type Physician Office
Lab Director SUDHAKAR JONNALAGADDA

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This page was last updated on: 6/4/2025