11D0977113 CLIA NUMBER - PREMIER SURGICAL PAVILION OF ATLANTA

Laboratory Demographics

CLIA Number: 11D0977113

Facility Name: PREMIER SURGICAL PAVILION OF ATLANTA

Facility Address:
1 BALTIMORE PLACE, SUITE 400
ATLANTA, GA
ZIP 30308
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Facility Phone Number: 404 410-0942

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1104301274

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D0977113
LAB Type	Ambulatory Surgery Center
Facility Name	PREMIER SURGICAL PAVILION OF ATLANTA
Street	1 BALTIMORE PLACE, SUITE 400
City	ATLANTA
State	GA
ZIP	30308
Phone	404 410-0942
CertificateType	4
CertificateEffectiveDate	8/22/2022
CertificateExpirationDate	8/21/2024
FacilityType	Waiver

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