11D2108805 CLIA NUMBER - AVVSC LAWRENCEVILLE

Laboratory Demographics

  • CLIA Code: 11D2108805
  • Facility Name: AVVSC LAWRENCEVILLE
  • Facility Address: 600 PROFESSIONAL DRIVE SUITE 160 B
    LAWRENCEVILLE, GA
    ZIP 30046
  • Facility Phone: 678 878-4555
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: AMISH TILARA
  • NPI Number: 1427435007
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2108805
LAB Type Ambulatory Surgery Center
Facility Name AVVSC LAWRENCEVILLE
Street 600 PROFESSIONAL DRIVE SUITE 160 B
City LAWRENCEVILLE
State GA
ZIP 30046
Phone 678 878-4555
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/12/2024
Certificate Expiration Date 2/11/2026
Facility Type Ambulatory Surgery Center
Lab Director AMISH TILARA

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