11D2036442 CLIA NUMBER - UROLOGICAL SURGICAL CENTER, LLC

Laboratory Demographics

  • CLIA Code: 11D2036442
  • Facility Name: UROLOGICAL SURGICAL CENTER, LLC
  • Facility Address: 102 HICKORY STREET
    WARNER ROBINS, GA
    ZIP 31093
  • Facility Phone: 478 333-6961
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: MR. MELVIN LEE FUSSELL
  • NPI Number: 1477033124
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 11D2036442
LAB Type Ambulatory Surgery Center
Facility Name UROLOGICAL SURGICAL CENTER, LLC
Street 102 HICKORY STREET
City WARNER ROBINS
State GA
ZIP 31093
Phone 478 333-6961
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/8/2024
Certificate Expiration Date 2/7/2026
Facility Type Ambulatory Surgery Center
Lab Director MR. MELVIN LEE FUSSELL

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This page was last updated on: 9/29/2025