11D1038200 CLIA NUMBER - EAST GEORGIA PEDIATRIC PC

Laboratory Demographics

  • CLIA Code: 11D1038200
  • Facility Name: EAST GEORGIA PEDIATRIC PC
  • Facility Address: 450 GEORGIA AVENUE, SUITE A
    STATESBORO, GA
    ZIP 30458
  • Facility Phone: 912 489-3325
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL C. DEAL
  • NPI Number: 1295999795
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 11D1038200
LAB Type Physician Office
Facility Name EAST GEORGIA PEDIATRIC PC
Street 450 GEORGIA AVENUE, SUITE A
City STATESBORO
State GA
ZIP 30458
Phone 912 489-3325
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/14/2025
Certificate Expiration Date 3/13/2027
Facility Type Physician Office
Lab Director MICHAEL C. DEAL

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