11D1013229 CLIA NUMBER - WESTSIDE ENDOSCOPY CENTER PC

Laboratory Demographics

  • CLIA Code: 11D1013229
  • Facility Name: WESTSIDE ENDOSCOPY CENTER PC
  • Facility Address: 3825 MEDICAL PARK DRIVE
    AUSTELL, GA
    ZIP 30106
  • Facility Phone: 678 945-9600
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JASMINE JEFFERS MD
  • NPI Number: 1487647483
  • Taxonomy: 261QE0800X - Clinic/Center

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/4/2023
Certificate Expiration Date 6/3/2025
Facility Type Ambulatory Surgery Center
Lab Director JASMINE JEFFERS MD

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This page was last updated on: 3/20/2025