11D1101895 CLIA NUMBER - BOLA SOGADE MD DBA OB GYN CONSULTANTS

Laboratory Demographics

CLIA Number: 11D1101895

Facility Name: BOLA SOGADE MD DBA OB GYN CONSULTANTS

Facility Address:
260 WEST CLINTON STREET
GRAY, GA
ZIP 31032
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Facility Phone Number: 478 745-3014

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1558455113

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	11D1101895
LAB Type	Physician Office
Facility Name	BOLA SOGADE MD DBA OB GYN CONSULTANTS
Street	260 WEST CLINTON STREET
City	GRAY
State	GA
ZIP	31032
Phone	478 745-3014
CertificateType	4
CertificateEffectiveDate	7/8/2023
CertificateExpirationDate	7/7/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024