11D2077870 CLIA NUMBER - SURGICARE GWINNETT, LLC

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Laboratory Demographics

CLIA Number: 11D2077870

Facility Name: SURGICARE GWINNETT, LLC

Facility Address:
367 ATHENS HIGHWAY
LOGANVILLE, GA
ZIP 30052
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Facility Phone Number: 678 466-6760

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1164833398

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2077870
LAB Type	Ambulatory Surgery Center
Facility Name	SURGICARE GWINNETT, LLC
Street	367 ATHENS HIGHWAY
City	LOGANVILLE
State	GA
ZIP	30052
Phone	678 466-6760
CertificateType	4
CertificateEffectiveDate	5/16/2024
CertificateExpirationDate	5/15/2026
FacilityType	Waiver

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