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11D1094704 CLIA NUMBER - GEORGIA UROLOGY FAYETTE AMBULATORY SURGERY CENTER

Laboratory Demographics

CLIA Number: 11D1094704

Facility Name: GEORGIA UROLOGY FAYETTE AMBULATORY SURGERY CENTER

Facility Address:
140 CARNEGIE PLACE, SUITE 108
FAYETTEVILLE, GA
ZIP 30214
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Facility Phone Number: 678 610-3395

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver
NPI Number: 1952541708

Taxonomy: 208800000X - Urology
A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

CLIA Record

Field Name Field Value
CLIA Number 11D1094704
LAB Type Ambulatory Surgery Center
Facility Name GEORGIA UROLOGY FAYETTE AMBULATORY SURGERY CENTER
Street 140 CARNEGIE PLACE, SUITE 108
City FAYETTEVILLE
State GA
ZIP 30214
Phone 678 610-3395
CertificateType 4
CertificateEffectiveDate 3/27/2024
CertificateExpirationDate 3/26/2026
FacilityType Waiver

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This page was last updated on: 4/23/2024