11D1069254 CLIA NUMBER - BALIGA FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 11D1069254
  • Facility Name: BALIGA FAMILY PRACTICE
  • Facility Address: 1400 BRADLEY LAKE BOULEVARD
    COLUMBUS, GA
    ZIP 31904
  • Facility Phone: 706 507-2050
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BANTWAL P. BALIGA
  • NPI Number: 1700094562
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1069254
LAB Type Physician Office
Facility Name BALIGA FAMILY PRACTICE
Street 1400 BRADLEY LAKE BOULEVARD
City COLUMBUS
State GA
ZIP 31904
Phone 706 507-2050
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/1/2025
Certificate Expiration Date 1/31/2027
Facility Type Physician Office
Lab Director BANTWAL P. BALIGA

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