11D1049968 CLIA NUMBER - GDC ENDOSCOPY CENTER LLC

Laboratory Demographics

  • CLIA Code: 11D1049968
  • Facility Name: GDC ENDOSCOPY CENTER LLC
  • Facility Address: 475 PHILIP BOULEVARD, SUITE 304
    LAWRENCEVILLE, GA
    ZIP 30045
  • Facility Phone: 678 377-8252
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: BHAVANENDREM INDRAKRISHNAN
  • NPI Number: 1811052749
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1049968
LAB Type Ambulatory Surgery Center
Facility Name GDC ENDOSCOPY CENTER LLC
Street 475 PHILIP BOULEVARD, SUITE 304
City LAWRENCEVILLE
State GA
ZIP 30045
Phone 678 377-8252
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/23/2024
Certificate Expiration Date 1/22/2026
Facility Type Ambulatory Surgery Center
Lab Director BHAVANENDREM INDRAKRISHNAN

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