11D2160341 CLIA NUMBER - TAKLE EYE SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 11D2160341
  • Facility Name: TAKLE EYE SURGERY CENTER, LLC
  • Facility Address: 1075 BANDY PARKWAY, SUITE 105
    LOCUST GROVE, GA
    ZIP 30248
  • Facility Phone: 770 228-3836
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: AUDREY M. WAITS
  • NPI Number: 1568665404
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 11D2160341
LAB Type Ambulatory Surgery Center
Facility Name TAKLE EYE SURGERY CENTER, LLC
Street 1075 BANDY PARKWAY, SUITE 105
City LOCUST GROVE
State GA
ZIP 30248
Phone 770 228-3836
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/9/2025
Certificate Expiration Date 1/8/2027
Facility Type Ambulatory Surgery Center
Lab Director AUDREY M. WAITS

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