11D1105860 CLIA NUMBER - GI CARE FOR IDS ENDOSCOPY CENTER LLC

Laboratory Demographics

CLIA Number: 11D1105860

Facility Name: GI CARE FOR IDS ENDOSCOPY CENTER LLC

Facility Address:
993D JOHNSON FERRY ROAD SUITE 100
ATLANTA, GA
ZIP 30342
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Facility Phone Number: 404 257-0799

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1053559542

Taxonomy: 261QE0800X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D1105860
LAB Type	Ambulatory Surgery Center
Facility Name	GI CARE FOR IDS ENDOSCOPY CENTER LLC
Street	993D JOHNSON FERRY ROAD SUITE 100
City	ATLANTA
State	GA
ZIP	30342
Phone	404 257-0799
CertificateType	4
CertificateEffectiveDate	9/30/2023
CertificateExpirationDate	9/29/2025
FacilityType	Waiver

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