11D2057790 CLIA NUMBER - PANOLA ENDOCSOPY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 11D2057790
  • Facility Name: PANOLA ENDOCSOPY CENTER, LLC
  • Facility Address: 550 PEACHTREE STREET, NE, SUITE 1660
    ATLANTA, GA
    ZIP 30308
  • Facility Phone: 404 881-1094
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: TOMMIE H. HAYWOOD III
  • NPI Number: 1275871147
  • Taxonomy: 261QE0800X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2057790
LAB Type Ambulatory Surgery Center
Facility Name PANOLA ENDOCSOPY CENTER, LLC
Street 550 PEACHTREE STREET, NE, SUITE 1660
City ATLANTA
State GA
ZIP 30308
Phone 404 881-1094
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/24/2025
Certificate Expiration Date 4/23/2027
Facility Type Ambulatory Surgery Center
Lab Director TOMMIE H. HAYWOOD III

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