11D2163350 CLIA NUMBER - WGUASC, LLC

Laboratory Demographics

  • CLIA Code: 11D2163350
  • Facility Name: WGUASC, LLC
  • Facility Address: 150 CLINIC AVENUE, SUITE 203
    CARROLLTON, GA
    ZIP 30117
  • Facility Phone: 770 834-6988
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Microscopy
  • Lab Director: CHRISTOPHER POWELL
  • NPI Number: 1275929184
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 11D2163350
LAB Type Ambulatory Surgery Center
Facility Name WGUASC, LLC
Street 150 CLINIC AVENUE, SUITE 203
City CARROLLTON
State GA
ZIP 30117
Phone 770 834-6988
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/2/2025
Certificate Expiration Date 8/1/2027
Facility Type Ambulatory Surgery Center
Lab Director CHRISTOPHER POWELL

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