11D1012004 CLIA NUMBER - SOUTHERN OB GYN AMBULATORY SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 11D1012004
  • Facility Name: SOUTHERN OB GYN AMBULATORY SURGERY CENTER
  • Facility Address: 341 CONNELL ROAD
    VALDOSTA, GA
    ZIP 31602
  • Facility Phone: 209 241-2800
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: ROY E. SWINDLE MD
  • NPI Number: 1013174457
  • Taxonomy: 213ES0103X - Podiatrist

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CLIA Record

Field Name Field Value
CLIA Number 11D1012004
LAB Type Ambulatory Surgery Center
Facility Name SOUTHERN OB GYN AMBULATORY SURGERY CENTER
Street 341 CONNELL ROAD
City VALDOSTA
State GA
ZIP 31602
Phone 209 241-2800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/29/2025
Certificate Expiration Date 4/28/2027
Facility Type Ambulatory Surgery Center
Lab Director ROY E. SWINDLE MD

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