11D1066229 CLIA NUMBER - WEST GEORGIA UROLOGY

Laboratory Demographics

  • CLIA Code: 11D1066229
  • Facility Name: WEST GEORGIA UROLOGY
  • Facility Address: 705 DALLAS HIGHWAY, SUITE 205
    VILLA RICA, GA
    ZIP 30180
  • Facility Phone: 770 834-6988
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CHRISTOPHER L. POWELL
  • NPI Number: 1043909302
  • Taxonomy: 332900000X - Non-Pharmacy Dispensing Site

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CLIA Record

Field Name Field Value
CLIA Number 11D1066229
LAB Type Physician Office
Facility Name WEST GEORGIA UROLOGY
Street 705 DALLAS HIGHWAY, SUITE 205
City VILLA RICA
State GA
ZIP 30180
Phone 770 834-6988
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 3/1/2025
Certificate Expiration Date 2/28/2027
Facility Type Physician Office
Lab Director CHRISTOPHER L. POWELL

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