11D2022796 CLIA NUMBER - CPMSC CARROLLTON, LLC

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Laboratory Demographics

CLIA Number: 11D2022796

Facility Name: CPMSC CARROLLTON, LLC

Facility Address:
812 SOUTH PARK STREET, SUITE 5 B
CARROLLTON, GA
ZIP 30117
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Facility Phone Number: 404 920-4950

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1316233612

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2022796
LAB Type	Ambulatory Surgery Center
Facility Name	CPMSC CARROLLTON, LLC
Street	812 SOUTH PARK STREET, SUITE 5 B
City	CARROLLTON
State	GA
ZIP	30117
Phone	404 920-4950
CertificateType	4
CertificateEffectiveDate	10/12/2023
CertificateExpirationDate	10/11/2025
FacilityType	Waiver

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