11D2278592 CLIA NUMBER - WEST GEORGIA SURGERY CENTER

Laboratory Demographics

CLIA Number: 11D2278592

Facility Name: WEST GEORGIA SURGERY CENTER

Facility Address:
103 CLINIC AVENUE
CARROLLTON, GA
ZIP 30117
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Facility Phone Number: 706 616-3686

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1952391591

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2278592
LAB Type	Ambulatory Surgery Center
Facility Name	WEST GEORGIA SURGERY CENTER
Street	103 CLINIC AVENUE
City	CARROLLTON
State	GA
ZIP	30117
Phone	706 616-3686
CertificateType	4
CertificateEffectiveDate	3/21/2023
CertificateExpirationDate	3/20/2025
FacilityType	Waiver

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