11D0954707 CLIA NUMBER - MACON OUTPATIENT SURGERY LLC

Laboratory Demographics

  • CLIA Code: 11D0954707
  • Facility Name: MACON OUTPATIENT SURGERY LLC
  • Facility Address: 3708 NORTHSIDE DRIVE
    MACON, GA
    ZIP 31210
  • Facility Phone: 478 254-5410
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: LYNN W. JOHNSON
  • NPI Number: 1386652667
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0954707
LAB Type Ambulatory Surgery Center
Facility Name MACON OUTPATIENT SURGERY LLC
Street 3708 NORTHSIDE DRIVE
City MACON
State GA
ZIP 31210
Phone 478 254-5410
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/7/2024
Certificate Expiration Date 12/6/2026
Facility Type Ambulatory Surgery Center
Lab Director LYNN W. JOHNSON

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