11D1011774 CLIA NUMBER - GAINESVILLE UROLOGY ASC LLC

Laboratory Demographics

  • CLIA Code: 11D1011774
  • Facility Name: GAINESVILLE UROLOGY ASC LLC
  • Facility Address: 1240 JESSIE JEWELL PARKWAY 250
    GAINESVILLE, GA
    ZIP 30501
  • Facility Phone: 770 287-1299
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: THOMAS M. FASSULIOTIS
  • NPI Number: 1245241694
  • Taxonomy: 261QA1903X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D1011774
LAB Type Ambulatory Surgery Center
Facility Name GAINESVILLE UROLOGY ASC LLC
Street 1240 JESSIE JEWELL PARKWAY 250
City GAINESVILLE
State GA
ZIP 30501
Phone 770 287-1299
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2025
Certificate Expiration Date 4/22/2027
Facility Type Ambulatory Surgery Center
Lab Director THOMAS M. FASSULIOTIS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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