11D1104074 CLIA NUMBER - NORTHWEST ENDOSCOPY CENTER LLC

Laboratory Demographics

  • CLIA Code: 11D1104074
  • Facility Name: NORTHWEST ENDOSCOPY CENTER LLC
  • Facility Address: 488 KENNESAW AVE NW SUITE 100
    MARIETTA, GA
    ZIP 30060
  • Facility Phone: 770 427-3075
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANNA V. LONGACRE
  • NPI Number: 1992941462
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1104074
LAB Type Physician Office
Facility Name NORTHWEST ENDOSCOPY CENTER LLC
Street 488 KENNESAW AVE NW SUITE 100
City MARIETTA
State GA
ZIP 30060
Phone 770 427-3075
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/25/2025
Certificate Expiration Date 8/24/2027
Facility Type Physician Office
Lab Director ANNA V. LONGACRE

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