11D0945212 CLIA NUMBER - AUGUSTA UROLOGY SURGICENTER LLC

Laboratory Demographics

  • CLIA Code: 11D0945212
  • Facility Name: AUGUSTA UROLOGY SURGICENTER LLC
  • Facility Address: 811 13TH STREET SUITE 17
    AUGUSTA, GA
    ZIP 30901
  • Facility Phone: 706 724-4111
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Microscopy
  • Lab Director: HENRY N. GOODWIN JR
  • NPI Number: 1114984523
  • Taxonomy: 261QA1903X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D0945212
LAB Type Ambulatory Surgery Center
Facility Name AUGUSTA UROLOGY SURGICENTER LLC
Street 811 13TH STREET SUITE 17
City AUGUSTA
State GA
ZIP 30901
Phone 706 724-4111
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 4/28/2024
Certificate Expiration Date 4/27/2026
Facility Type Ambulatory Surgery Center
Lab Director HENRY N. GOODWIN JR

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 6/4/2025