11D2255653 CLIA NUMBER - SOUTHEAST MEDICAL GROUP DBA MEDICAL GRP OF CENTRAL GA

Laboratory Demographics

  • CLIA Code: 11D2255653
  • Facility Name: SOUTHEAST MEDICAL GROUP DBA MEDICAL GRP OF CENTRAL GA
  • Facility Address: 18 S BROAD STREET
    BUTLER, GA
    ZIP 31006
  • Facility Phone: 478 837-7121
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MOHAMMAD AL-SHROOF
  • NPI Number: 1689320640
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2255653
LAB Type Physician Office
Facility Name SOUTHEAST MEDICAL GROUP DBA MEDICAL GRP OF CENTRAL GA
Street 18 S BROAD STREET
City BUTLER
State GA
ZIP 31006
Phone 478 837-7121
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2023
Certificate Expiration Date 10/31/2025
Facility Type Physician Office
Lab Director MOHAMMAD AL-SHROOF

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