11D2153225 CLIA NUMBER - PEDIATRIC AND ADULT SURGERY CENTER OF ATLANTA, LLC

Laboratory Demographics

CLIA Number: 11D2153225

Facility Name: PEDIATRIC AND ADULT SURGERY CENTER OF ATLANTA, LLC

Facility Address:
2061 PEACHTREE ROAD, SUITE 300 A
ATLANTA, GA
ZIP 30309
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Facility Phone Number: 678 483-8833

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1750862389

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2153225
LAB Type	Ambulatory Surgery Center
Facility Name	PEDIATRIC AND ADULT SURGERY CENTER OF ATLANTA, LLC
Street	2061 PEACHTREE ROAD, SUITE 300 A
City	ATLANTA
State	GA
ZIP	30309
Phone	678 483-8833
CertificateType	4
CertificateEffectiveDate	8/23/2022
CertificateExpirationDate	8/22/2024
FacilityType	Waiver

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