11D1081579 CLIA NUMBER - SOUTHERN INTERNAL MEDICINE LLC

Laboratory Demographics

  • CLIA Code: 11D1081579
  • Facility Name: SOUTHERN INTERNAL MEDICINE LLC
  • Facility Address: 106 ROWE STREET
    DUBLIN, GA
    ZIP 31021
  • Facility Phone: 478 272-0353
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MANOJKUMAR C. PATEL
  • NPI Number: 1316121619
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1081579
LAB Type Physician Office
Facility Name SOUTHERN INTERNAL MEDICINE LLC
Street 106 ROWE STREET
City DUBLIN
State GA
ZIP 31021
Phone 478 272-0353
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/20/2024
Certificate Expiration Date 3/19/2026
Facility Type Physician Office
Lab Director MANOJKUMAR C. PATEL

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