11D1040008 CLIA NUMBER - RUSSELL G ONEAL MD LLC

Laboratory Demographics

  • CLIA Code: 11D1040008
  • Facility Name: RUSSELL G ONEAL MD LLC
  • Facility Address: 1760 BASS ROAD, SUITE 200A
    MACON, GA
    ZIP 31210
  • Facility Phone: 478 309-1212
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: EDWARD T. THARPE
  • NPI Number: 1952415853
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1040008
LAB Type Physician Office
Facility Name RUSSELL G ONEAL MD LLC
Street 1760 BASS ROAD, SUITE 200A
City MACON
State GA
ZIP 31210
Phone 478 309-1212
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 4/27/2025
Certificate Expiration Date 4/26/2027
Facility Type Physician Office
Lab Director EDWARD T. THARPE

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