11D1023871 CLIA NUMBER - RENAISSANCE SURGICAL CENTER LLC

Laboratory Demographics

  • CLIA Code: 11D1023871
  • Facility Name: RENAISSANCE SURGICAL CENTER LLC
  • Facility Address: 4030 RIVERSIDE PARK BOULEVARD
    MACON, GA
    ZIP 31210
  • Facility Phone: (478) 477-6425
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: ROY POWELL JR
  • NPI Number: 1063604791
  • Taxonomy: 174400000X - Specialist

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D1023871
LAB Type Ambulatory Surgery Center
Facility Name RENAISSANCE SURGICAL CENTER LLC
Street 4030 RIVERSIDE PARK BOULEVARD
City MACON
State GA
ZIP 31210
Phone 4784776425
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/29/2026
Certificate Expiration Date 3/28/2028
Facility Type Ambulatory Surgery Center
Lab Director ROY POWELL JR

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: 5/18/2026