11D2143065 CLIA NUMBER - EAR NOSE & THROAT FACIAL PLASTICS AND SLEEP DISORDER CENTER, ASC, LLC

Laboratory Demographics

CLIA Number: 11D2143065

Facility Name: EAR NOSE & THROAT FACIAL PLASTICS AND SLEEP DISORDER CENTER, ASC, LLC

Facility Address:
601 PRYOR STREET, SW
ATLANTA, GA
ZIP 30312
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Facility Phone Number: 404 350-9200

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1730334582

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	11D2143065
LAB Type	Ambulatory Surgery Center
Facility Name	EAR NOSE & THROAT FACIAL PLASTICS AND SLEEP DISORDER CENTER, ASC, LLC
Street	601 PRYOR STREET, SW
City	ATLANTA
State	GA
ZIP	30312
Phone	404 350-9200
CertificateType	4
CertificateEffectiveDate	1/24/2024
CertificateExpirationDate	1/23/2026
FacilityType	Waiver

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