11D1067660 CLIA NUMBER - NORTHWEST PLAZA ASC

Laboratory Demographics

  • CLIA Code: 11D1067660
  • Facility Name: NORTHWEST PLAZA ASC
  • Facility Address: 2311 LAKE PARK DRIVE
    ALBANY, GA
    ZIP 31707
  • Facility Phone: 229 317-0742
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: BOBBY DARRELL PRINCE
  • NPI Number: 1528196888
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1067660
LAB Type Ambulatory Surgery Center
Facility Name NORTHWEST PLAZA ASC
Street 2311 LAKE PARK DRIVE
City ALBANY
State GA
ZIP 31707
Phone 229 317-0742
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/24/2025
Certificate Expiration Date 4/23/2027
Facility Type Ambulatory Surgery Center
Lab Director BOBBY DARRELL PRINCE

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