11D2027889 CLIA NUMBER - CPMSC GWINNETT, LLC

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Laboratory Demographics

CLIA Number: 11D2027889

Facility Name: CPMSC GWINNETT, LLC

Facility Address:
4799 SUGAR LOAF PARKWAY, BUILDING G, STE 110
LAWRENCEVILLE, GA
ZIP 30044
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Facility Phone Number: 770 929-9033

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1144516451

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2027889
LAB Type	Ambulatory Surgery Center
Facility Name	CPMSC GWINNETT, LLC
Street	4799 SUGAR LOAF PARKWAY, BUILDING G, STE 110
City	LAWRENCEVILLE
State	GA
ZIP	30044
Phone	770 929-9033
CertificateType	4
CertificateEffectiveDate	1/24/2023
CertificateExpirationDate	1/23/2025
FacilityType	Waiver

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