11D2077987 CLIA NUMBER - COLON AND RECTAL CLINIC LLC

Laboratory Demographics

  • CLIA Code: 11D2077987
  • Facility Name: COLON AND RECTAL CLINIC LLC
  • Facility Address: 3905 JOHNS CREEK COURT, SUITE 200
    SUWANEE, GA
    ZIP 30024
  • Facility Phone: 770 495-0799
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KOTA R. VENKATESH
  • NPI Number: 1003243072
  • Taxonomy: 208C00000X - Colon & Rectal Surgery

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CLIA Record

Field Name Field Value
CLIA Number 11D2077987
LAB Type Physician Office
Facility Name COLON AND RECTAL CLINIC LLC
Street 3905 JOHNS CREEK COURT, SUITE 200
City SUWANEE
State GA
ZIP 30024
Phone 770 495-0799
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/20/2024
Certificate Expiration Date 5/19/2026
Facility Type Physician Office
Lab Director KOTA R. VENKATESH

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