11D1072063 CLIA NUMBER - ELITE SURGICAL PC

Laboratory Demographics

  • CLIA Code: 11D1072063
  • Facility Name: ELITE SURGICAL PC
  • Facility Address: 3969 S COBB DRIVE SE, SUITE 202
    SMYRNA, GA
    ZIP 30080
  • Facility Phone: 770 438-9191
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BAHEEGH L. SHADEED MD
  • NPI Number: 1588094106
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 11D1072063
LAB Type Physician Office
Facility Name ELITE SURGICAL PC
Street 3969 S COBB DRIVE SE, SUITE 202
City SMYRNA
State GA
ZIP 30080
Phone 770 438-9191
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2024
Certificate Expiration Date 4/27/2026
Facility Type Physician Office
Lab Director BAHEEGH L. SHADEED MD

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