11D0976586 CLIA NUMBER - DALTON PLASTIC SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 11D0976586
  • Facility Name: DALTON PLASTIC SURGERY CENTER
  • Facility Address: 1501 BROADRICK DRIVE, SUITE #1
    DALTON, GA
    ZIP 30720
  • Facility Phone: 706 226-3311
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: SHERRILL R. REGINALD
  • NPI Number: 1659606408
  • Taxonomy: 208200000X - Plastic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 11D0976586
LAB Type Ambulatory Surgery Center
Facility Name DALTON PLASTIC SURGERY CENTER
Street 1501 BROADRICK DRIVE, SUITE #1
City DALTON
State GA
ZIP 30720
Phone 706 226-3311
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/9/2024
Certificate Expiration Date 8/8/2026
Facility Type Ambulatory Surgery Center
Lab Director SHERRILL R. REGINALD

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