11D1072747 CLIA NUMBER - GI ENDOSCOPY CENTER

Laboratory Demographics

  • CLIA Code: 11D1072747
  • Facility Name: GI ENDOSCOPY CENTER
  • Facility Address: 6555 PROFESSIONAL PLACE SUITE B
    RIVERDALE, GA
    ZIP 30274
  • Facility Phone: 770 692-0100
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JAY PRAKASH
  • NPI Number: 1861596967
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1072747
LAB Type Ambulatory Surgery Center
Facility Name GI ENDOSCOPY CENTER
Street 6555 PROFESSIONAL PLACE SUITE B
City RIVERDALE
State GA
ZIP 30274
Phone 770 692-0100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/23/2025
Certificate Expiration Date 8/22/2027
Facility Type Ambulatory Surgery Center
Lab Director JAY PRAKASH

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