11D2186447 CLIA NUMBER - CPMSC CANTON, LLC

Laboratory Demographics

  • CLIA Code: 11D2186447
  • Facility Name: CPMSC CANTON, LLC
  • Facility Address: 134 RIVERSTONE TERRACE, SUITE 102
    CANTON, GA
    ZIP 30114
  • Facility Phone: 404 920-4950
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: EDUARDO ESCORCIA
  • NPI Number: 1952737207
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2186447
LAB Type Ambulatory Surgery Center
Facility Name CPMSC CANTON, LLC
Street 134 RIVERSTONE TERRACE, SUITE 102
City CANTON
State GA
ZIP 30114
Phone 404 920-4950
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/17/2024
Certificate Expiration Date 6/16/2026
Facility Type Ambulatory Surgery Center
Lab Director EDUARDO ESCORCIA

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