11D0970857 CLIA NUMBER - SOUTHERN ENDOSCOPY SUITE LLC

Laboratory Demographics

CLIA Number: 11D0970857

Facility Name: SOUTHERN ENDOSCOPY SUITE LLC

Facility Address:
763 OLD NORCROSS RD
LAWRENCEVILLE, GA
ZIP 30046
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Facility Phone Number: 678 985-2000

Facility Type: Independent

Certificate Type: Waiver

NPI Number: 1215986609

Taxonomy: 261QE0800X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	12/19/2022
CertificateExpirationDate	12/18/2024
FacilityType	Waiver

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