11D2285283 CLIA NUMBER - SOUTHEAST MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 11D2285283
  • Facility Name: SOUTHEAST MEDICAL GROUP
  • Facility Address: 1504 N THORNTON AVENUE, SUITE 107
    DALTON, GA
    ZIP 30720
  • Facility Phone: 470 704-3634
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THOMAS E. BAT
  • NPI Number: 1891666210
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2285283
LAB Type Physician Office
Facility Name SOUTHEAST MEDICAL GROUP
Street 1504 N THORNTON AVENUE, SUITE 107
City DALTON
State GA
ZIP 30720
Phone 470 704-3634
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/11/2025
Certificate Expiration Date 7/10/2027
Facility Type Physician Office
Lab Director THOMAS E. BAT

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