11D0961724 CLIA NUMBER - GEORGIA SURGICAL CENTER ON PEACHTREE

Laboratory Demographics

CLIA Number: 11D0961724

Facility Name: GEORGIA SURGICAL CENTER ON PEACHTREE

Facility Address:
2061 PEACHTREE ROAD, NW, SUITE 100
ATLANTA, GA
ZIP 30309
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Facility Phone Number: 404 351-0083

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1437250248

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D0961724
LAB Type	Ambulatory Surgery Center
Facility Name	GEORGIA SURGICAL CENTER ON PEACHTREE
Street	2061 PEACHTREE ROAD, NW, SUITE 100
City	ATLANTA
State	GA
ZIP	30309
Phone	404 351-0083
CertificateType	4
CertificateEffectiveDate	6/15/2023
CertificateExpirationDate	6/14/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024