11D2266575 CLIA NUMBER - PROVIDENCE OB/GYN, LLC

Laboratory Demographics

  • CLIA Code: 11D2266575
  • Facility Name: PROVIDENCE OB/GYN, LLC
  • Facility Address: 104 FAIRVIEW PARK DRIVE, SUITE 300
    DUBLIN, GA
    ZIP 31021
  • Facility Phone: 478 246-4304
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LAURI W. BULLEN
  • NPI Number: 1124750369
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2266575
LAB Type Physician Office
Facility Name PROVIDENCE OB/GYN, LLC
Street 104 FAIRVIEW PARK DRIVE, SUITE 300
City DUBLIN
State GA
ZIP 31021
Phone 478 246-4304
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/12/2024
Certificate Expiration Date 8/11/2026
Facility Type Physician Office
Lab Director LAURI W. BULLEN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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