11D1044369 CLIA NUMBER - SOUTHEAST MEDICAL GROUP DBA WOODSTOCK FAMILY PRACTICE & URGENT CARE

Laboratory Demographics

  • CLIA Code: 11D1044369
  • Facility Name: SOUTHEAST MEDICAL GROUP DBA WOODSTOCK FAMILY PRACTICE & URGENT CARE
  • Facility Address: 310 GOLD CREEK TRAIL, SUITE 200
    WOODSTOCK, GA
    ZIP 30188
  • Facility Phone: 470 704-3634
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMES Y. LEE
  • NPI Number: 1518198852
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1044369
LAB Type Physician Office
Facility Name SOUTHEAST MEDICAL GROUP DBA WOODSTOCK FAMILY PRACTICE & URGENT CARE
Street 310 GOLD CREEK TRAIL, SUITE 200
City WOODSTOCK
State GA
ZIP 30188
Phone 470 704-3634
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/19/2025
Certificate Expiration Date 8/18/2027
Facility Type Physician Office
Lab Director JAMES Y. LEE

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