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11D1002726 CLIA NUMBER - ATLANTA MINIMALLY INVASIVE GYNEGOLOGICAL SURGICAL CENTER

Laboratory Demographics

CLIA Number: 11D1002726

Facility Name: ATLANTA MINIMALLY INVASIVE GYNEGOLOGICAL SURGICAL CENTER

Facility Address:
105 COLLIER ROAD, NW, SUITE 1010
ATLANTA, GA
ZIP 30309
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Facility Phone Number: 404 355-4885

Facility Type: Physician Office

Certificate Type: Microscopy
NPI Number: 1780853200

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name Field Value
CLIA Number 11D1002726
LAB Type Physician Office
Facility Name ATLANTA MINIMALLY INVASIVE GYNEGOLOGICAL SURGICAL CENTER
Street 105 COLLIER ROAD, NW, SUITE 1010
City ATLANTA
State GA
ZIP 30309
Phone 404 355-4885
CertificateType 3
CertificateEffectiveDate 8/14/2022
CertificateExpirationDate 8/13/2024
FacilityType PPMP

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