11D1028055 CLIA NUMBER - COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC

Laboratory Demographics

  • CLIA Code: 11D1028055
  • Facility Name: COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC
  • Facility Address: 300 SHIRLEY AVENUE
    DOUGLAS, GA
    ZIP 31533
  • Facility Phone: 912 384-7275
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: SUDHAKAR JONNALAGADDA
  • NPI Number: 1861659294
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1028055
LAB Type Ambulatory Surgery Center
Facility Name COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC
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 7/20/2024
Certificate Expiration Date 7/19/2026
Facility Type Ambulatory Surgery Center
Lab Director SUDHAKAR JONNALAGADDA

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