11D2100880 CLIA NUMBER - GEORGIA UROLOGY AMBULATORY SURGERY CENTER

Laboratory Demographics

CLIA Number: 11D2100880

Facility Name: GEORGIA UROLOGY AMBULATORY SURGERY CENTER

Facility Address:
11835 ALPHARETTA HIGHWAY, SUITE 100
ROSWELL, GA
ZIP 30076
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Facility Phone Number: 678 284-4686

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1316162506

Taxonomy: 208800000X - Urology
A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

CLIA Record

Field Name	Field Value
CLIA Number	11D2100880
LAB Type	Physician Office
Facility Name	GEORGIA UROLOGY AMBULATORY SURGERY CENTER
Street	11835 ALPHARETTA HIGHWAY, SUITE 100
City	ROSWELL
State	GA
ZIP	30076
Phone	678 284-4686
CertificateType	3
CertificateEffectiveDate	8/27/2023
CertificateExpirationDate	8/26/2025
FacilityType	PPMP

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