11D2004903 CLIA NUMBER - CARROLLTON SURGICAL GROUP

Laboratory Demographics

  • CLIA Code: 11D2004903
  • Facility Name: CARROLLTON SURGICAL GROUP
  • Facility Address: 690 DALLAS HIGHWAY, SUITE 207
    VILLA RICA, GA
    ZIP 30180
  • Facility Phone: 770 456-3646
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. AUSTIN LEWIS
  • NPI Number: 1043670243
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2004903
LAB Type Physician Office
Facility Name CARROLLTON SURGICAL GROUP
Street 690 DALLAS HIGHWAY, SUITE 207
City VILLA RICA
State GA
ZIP 30180
Phone 770 456-3646
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/16/2024
Certificate Expiration Date 3/15/2026
Facility Type Physician Office
Lab Director DR. AUSTIN LEWIS

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This page was last updated on: 3/20/2025