11D2274313 CLIA NUMBER - SOUTHEAST MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 11D2274313
  • Facility Name: SOUTHEAST MEDICAL GROUP
  • Facility Address: 1555 BRAMPTON AVENUE
    STATESBORO, GA
    ZIP 30458
  • Facility Phone: 770 442-1911
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THOMAS BAT
  • NPI Number: 1285701482
  • Taxonomy: 261QM1200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2274313
LAB Type Physician Office
Facility Name SOUTHEAST MEDICAL GROUP
Street 1555 BRAMPTON AVENUE
City STATESBORO
State GA
ZIP 30458
Phone 770 442-1911
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/3/2025
Certificate Expiration Date 1/2/2027
Facility Type Physician Office
Lab Director THOMAS BAT

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