11D0963955 CLIA NUMBER - AMBULATORY LASER & SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 11D0963955
  • Facility Name: AMBULATORY LASER & SURGERY CENTER
  • Facility Address: 425 FOREST PKWY STE 103
    FOREST PARK, GA
    ZIP 30297
  • Facility Phone: 404 363-9944
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: PAUL A. COLON
  • NPI Number: 1730360264
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0963955
LAB Type Ambulatory Surgery Center
Facility Name AMBULATORY LASER & SURGERY CENTER
Street 425 FOREST PKWY STE 103
City FOREST PARK
State GA
ZIP 30297
Phone 404 363-9944
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/17/2025
Certificate Expiration Date 8/16/2027
Facility Type Ambulatory Surgery Center
Lab Director PAUL A. COLON

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