11D1094704 CLIA NUMBER - GEORGIA UROLOGY FAYETTE AMBULATORY SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 11D1094704
  • Facility Name: GEORGIA UROLOGY FAYETTE AMBULATORY SURGERY CENTER
  • Facility Address: 1336 HWY 54W BLDG 100 SUITE 101
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 678 610-3395
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHN ABBOTT
  • NPI Number: 1952541708
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 11D1094704
LAB Type Physician Office
Facility Name GEORGIA UROLOGY FAYETTE AMBULATORY SURGERY CENTER
Street 1336 HWY 54W BLDG 100 SUITE 101
City FAYETTEVILLE
State GA
ZIP 30214
Phone 678 610-3395
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/27/2024
Certificate Expiration Date 3/26/2026
Facility Type Physician Office
Lab Director JOHN ABBOTT

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