11D1036594 CLIA NUMBER - SOUTHEAST MEDICAL GROUP DBA MED GRP OF CENTRAL GA

Laboratory Demographics

  • CLIA Code: 11D1036594
  • Facility Name: SOUTHEAST MEDICAL GROUP DBA MED GRP OF CENTRAL GA
  • Facility Address: 2054 WATSON BOULEVARD
    WARNER ROBINS, GA
    ZIP 31093
  • Facility Phone: 478 918-0770
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MOHAMMAD AL-SHROOF
  • NPI Number: 1861448110
  • Taxonomy: 207RA0201X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1036594
LAB Type Physician Office
Facility Name SOUTHEAST MEDICAL GROUP DBA MED GRP OF CENTRAL GA
Street 2054 WATSON BOULEVARD
City WARNER ROBINS
State GA
ZIP 31093
Phone 478 918-0770
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/7/2025
Certificate Expiration Date 2/6/2027
Facility Type Physician Office
Lab Director MOHAMMAD AL-SHROOF

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