11D2274313 CLIA NUMBER - SOUTHEAST MEDICAL GROUP

Laboratory Demographics

CLIA Number: 11D2274313

Facility Name: SOUTHEAST MEDICAL GROUP

Facility Address:
1555 BRAMPTON AVENUE
STATESBORO, GA
ZIP 30458
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Facility Phone Number: 770 442-1911

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1285701482

Taxonomy: 261QM1200X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	1/3/2023
CertificateExpirationDate	1/2/2025
FacilityType	Waiver

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