11D2149820 CLIA NUMBER - SOUTH EAST HOSPICE, LLC

Laboratory Demographics

  • CLIA Code: 11D2149820
  • Facility Name: SOUTH EAST HOSPICE, LLC
  • Facility Address: 3736 EXECUTIVE CENTER DRIVE
    MARTINEZ, GA
    ZIP 30907
  • Facility Phone: 706 364-3108
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: TINA MATTEO
  • NPI Number: 1144600875
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 11D2149820
LAB Type Hospice
Facility Name SOUTH EAST HOSPICE, LLC
Street 3736 EXECUTIVE CENTER DRIVE
City MARTINEZ
State GA
ZIP 30907
Phone 706 364-3108
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/12/2024
Certificate Expiration Date 6/11/2026
Facility Type Hospice
Lab Director TINA MATTEO

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