11D2077870 CLIA NUMBER - SURGICARE GWINNETT, LLC

Laboratory Demographics

  • CLIA Code: 11D2077870
  • Facility Name: SURGICARE GWINNETT, LLC
  • Facility Address: 367 ATHENS HIGHWAY
    LOGANVILLE, GA
    ZIP 30052
  • Facility Phone: 678 466-6760
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: CHRISTOPHER IBIKUNIE
  • NPI Number: 1164833398
  • Taxonomy: 261QA1903X - Clinic/Center

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/16/2024
Certificate Expiration Date 5/15/2026
Facility Type Ambulatory Surgery Center
Lab Director CHRISTOPHER IBIKUNIE

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This page was last updated on: 6/4/2025