11D0985495 CLIA NUMBER - LAWRENCEVILLE SURGERY CENTER

Laboratory Demographics

CLIA Number: 11D0985495

Facility Name: LAWRENCEVILLE SURGERY CENTER

Facility Address:
758 OLD NORCROSS ROAD STE 125
LAWRENCEVILLE, GA
ZIP 30045
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Facility Phone Number: 678 987-0820

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1588619811

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D0985495
LAB Type	Ambulatory Surgery Center
Facility Name	LAWRENCEVILLE SURGERY CENTER
Street	758 OLD NORCROSS ROAD STE 125
City	LAWRENCEVILLE
State	GA
ZIP	30045
Phone	678 987-0820
CertificateType	4
CertificateEffectiveDate	4/20/2023
CertificateExpirationDate	4/19/2025
FacilityType	Waiver

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