11D0874183 CLIA NUMBER - NORTHEAST GA PLASTIC SURGERY ASSOC PC

Laboratory Demographics

  • CLIA Code: 11D0874183
  • Facility Name: NORTHEAST GA PLASTIC SURGERY ASSOC PC
  • Facility Address: 1296 SIMS STREET NE SUITE B
    GAINESVILLE, GA
    ZIP 30501
  • Facility Phone: 770 534-1856
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: SAM W. RICHWINE JR
  • NPI Number: 1306028238
  • Taxonomy: 208200000X - Plastic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 11D0874183
LAB Type Ambulatory Surgery Center
Facility Name NORTHEAST GA PLASTIC SURGERY ASSOC PC
Street 1296 SIMS STREET NE SUITE B
City GAINESVILLE
State GA
ZIP 30501
Phone 770 534-1856
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/5/2025
Certificate Expiration Date 8/4/2027
Facility Type Ambulatory Surgery Center
Lab Director SAM W. RICHWINE JR

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