11D0970857 CLIA NUMBER - SOUTHERN ENDOSCOPY SUITE LLC

Laboratory Demographics

  • CLIA Code: 11D0970857
  • Facility Name: SOUTHERN ENDOSCOPY SUITE LLC
  • Facility Address: 763 OLD NORCROSS RD
    LAWRENCEVILLE, GA
    ZIP 30046
  • Facility Phone: 678 985-2000
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: ROBERT KEITH WADE
  • NPI Number: 1215986609
  • Taxonomy: 261QE0800X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0970857
LAB Type Independent
Facility Name SOUTHERN ENDOSCOPY SUITE LLC
Street 763 OLD NORCROSS RD
City LAWRENCEVILLE
State GA
ZIP 30046
Phone 678 985-2000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/19/2024
Certificate Expiration Date 12/18/2026
Facility Type Independent
Lab Director ROBERT KEITH WADE

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