11D1077432 CLIA NUMBER - SOUTHEAST MEDICAL GROUP DBA SY MED

Laboratory Demographics

  • CLIA Code: 11D1077432
  • Facility Name: SOUTHEAST MEDICAL GROUP DBA SY MED
  • Facility Address: 4865 LAVISTA ROAD, SUITE A
    TUCKER, GA
    ZIP 30084
  • Facility Phone: 770 442-1911
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SYAMALA D. ERRAMILLI
  • NPI Number: 1679754337
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1077432
LAB Type Physician Office
Facility Name SOUTHEAST MEDICAL GROUP DBA SY MED
Street 4865 LAVISTA ROAD, SUITE A
City TUCKER
State GA
ZIP 30084
Phone 770 442-1911
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/9/2025
Certificate Expiration Date 3/8/2027
Facility Type Physician Office
Lab Director SYAMALA D. ERRAMILLI

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