11D2288223 CLIA NUMBER - CSRA HEALTH LLC

Laboratory Demographics

  • CLIA Code: 11D2288223
  • Facility Name: CSRA HEALTH LLC
  • Facility Address: 699 FURYS FERRY ROAD
    MARTINEZ, GA
    ZIP 30907
  • Facility Phone: 706 250-2122
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DEEPA JAGDALE
  • NPI Number: 1467143313
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D2288223
LAB Type Physician Office
Facility Name CSRA HEALTH LLC
Street 699 FURYS FERRY ROAD
City MARTINEZ
State GA
ZIP 30907
Phone 706 250-2122
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/23/2025
Certificate Expiration Date 8/22/2027
Facility Type Physician Office
Lab Director DEEPA JAGDALE

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