11D2147174 CLIA NUMBER - ALPHARETTA EYE SURGERY CENTER

Laboratory Demographics

CLIA Number: 11D2147174

Facility Name: ALPHARETTA EYE SURGERY CENTER

Facility Address:
2555 WESTSIDE PARKWAY, SUITE 325
ALPHARETTA, GA
ZIP 30004
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Facility Phone Number: 678 381-2020

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1164938825

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2147174
LAB Type	Ambulatory Surgery Center
Facility Name	ALPHARETTA EYE SURGERY CENTER
Street	2555 WESTSIDE PARKWAY, SUITE 325
City	ALPHARETTA
State	GA
ZIP	30004
Phone	678 381-2020
CertificateType	4
CertificateEffectiveDate	4/16/2024
CertificateExpirationDate	4/15/2026
FacilityType	Waiver

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