11D2256761 CLIA NUMBER - JASPER SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 11D2256761
  • Facility Name: JASPER SURGERY CENTER, LLC
  • Facility Address: 1101 OLD PHILADELPHIA ROAD SUITE G200
    JASPER, GA
    ZIP 30143
  • Facility Phone: 678 971-4167
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JORDAN TATE
  • NPI Number: 1730842311
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2256761
LAB Type Ambulatory Surgery Center
Facility Name JASPER SURGERY CENTER, LLC
Street 1101 OLD PHILADELPHIA ROAD SUITE G200
City JASPER
State GA
ZIP 30143
Phone 678 971-4167
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/28/2024
Certificate Expiration Date 3/27/2026
Facility Type Ambulatory Surgery Center
Lab Director JORDAN TATE

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