11D1016538 CLIA NUMBER - SOUTHERN CRESCENT ENDOSCOPY SUITE, LLC

Laboratory Demographics

  • CLIA Code: 11D1016538
  • Facility Name: SOUTHERN CRESCENT ENDOSCOPY SUITE, LLC
  • Facility Address: 150 NORTH PARK TRAIL
    STOCKBRIDGE, GA
    ZIP 30281
  • Facility Phone: 770 507-0909
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: CHRISTOPHER A. BROWN
  • NPI Number: 1548252562
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D1016538
LAB Type Ambulatory Surgery Center
Facility Name SOUTHERN CRESCENT ENDOSCOPY SUITE, LLC
Street 150 NORTH PARK TRAIL
City STOCKBRIDGE
State GA
ZIP 30281
Phone 770 507-0909
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/2/2025
Certificate Expiration Date 9/1/2027
Facility Type Ambulatory Surgery Center
Lab Director CHRISTOPHER A. BROWN

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