11D1084463 CLIA NUMBER - CPM SURGERY CENTER ,LLC

Laboratory Demographics

  • CLIA Code: 11D1084463
  • Facility Name: CPM SURGERY CENTER ,LLC
  • Facility Address: 3870 MEDICAL PARK DRIVE SUITE 100
    AUSTELL, GA
    ZIP 30106
  • Facility Phone: 770 929-9033
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: PALLAVI GUPTA
  • NPI Number: 1124277959
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1084463
LAB Type Ambulance
Facility Name CPM SURGERY CENTER ,LLC
Street 3870 MEDICAL PARK DRIVE SUITE 100
City AUSTELL
State GA
ZIP 30106
Phone 770 929-9033
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/23/2024
Certificate Expiration Date 5/22/2026
Facility Type Ambulance
Lab Director PALLAVI GUPTA

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