11D2310664 CLIA NUMBER - GEORGIA UROLOGY AMBULATORY SURGERY CENTER

Laboratory Demographics

CLIA Code: 11D2310664
Facility Name: GEORGIA UROLOGY AMBULATORY SURGERY CENTER
Facility Address: 1223 FRIENDSHIP ROAD, BLDG 400,SUITE 110
BRASELTON, GA
ZIP 30517
Facility Phone: (770) 963-2451
Facility Type: Physician Office
Facility Type: Microscopy
Lab Director: BRENT SHARPE
NPI Number: 1053536243
Taxonomy: 208800000X - Urology

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CLIA Record

Field Name	Field Value
CLIA Number	11D2310664
LAB Type	Physician Office
Facility Name	GEORGIA UROLOGY AMBULATORY SURGERY CENTER
Street	1223 FRIENDSHIP ROAD, BLDG 400,SUITE 110
City	BRASELTON
State	GA
ZIP	30517
Phone	7709632451
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	9/9/2024
Certificate Expiration Date	9/8/2026
Facility Type	Physician Office
Lab Director	BRENT SHARPE

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This page was last updated on: 5/18/2026