11D1013229 CLIA NUMBER - WESTSIDE ENDOSCOPY CENTER PC

Laboratory Demographics

CLIA Number: 11D1013229

Facility Name: WESTSIDE ENDOSCOPY CENTER PC

Facility Address:
3825 MEDICAL PARK DRIVE
AUSTELL, GA
ZIP 30106
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Facility Phone Number: 678 945-9600

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1487647483

Taxonomy: 261QE0800X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D1013229
LAB Type	Ambulatory Surgery Center
Facility Name	WESTSIDE ENDOSCOPY CENTER PC
Street	3825 MEDICAL PARK DRIVE
City	AUSTELL
State	GA
ZIP	30106
Phone	678 945-9600
CertificateType	4
CertificateEffectiveDate	6/4/2023
CertificateExpirationDate	6/3/2025
FacilityType	Waiver

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