11D2029444 CLIA NUMBER - GASTROINTESTINAL DIAG ENDORSCOPY WOODSTOCK, LLC DBA TOWN LAKE ENDOSCOPY CENTER

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Laboratory Demographics

CLIA Number: 11D2029444

Facility Name: GASTROINTESTINAL DIAG ENDORSCOPY WOODSTOCK, LLC DBA TOWN LAKE ENDOSCOPY CENTER

Facility Address:
118 MILL STREET, SUITE 100
WOODSTOCK, GA
ZIP 30188
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Facility Phone Number: 770 226-9070

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1760778765

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2029444
LAB Type	Ambulatory Surgery Center
Facility Name	GASTROINTESTINAL DIAG ENDORSCOPY WOODSTOCK, LLC DBA TOWN LAKE ENDOSCOPY CENTER
Street	118 MILL STREET, SUITE 100
City	WOODSTOCK
State	GA
ZIP	30188
Phone	770 226-9070
CertificateType	4
CertificateEffectiveDate	9/8/2023
CertificateExpirationDate	9/7/2025
FacilityType	Waiver

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