42D1074839 CLIA NUMBER - ATLANTIC UROLOGY CLINICS, LLC DBA ADULT & PEDIATRIC UROLOGY

Laboratory Demographics

  • CLIA Code: 42D1074839
  • Facility Name: ATLANTIC UROLOGY CLINICS, LLC DBA ADULT & PEDIATRIC UROLOGY
  • Facility Address: 3600 SEA MOUNTAIN HIGHWAY, SUITE B
    LITTLE RIVER, SC
    ZIP 29566
  • Facility Phone: 843 399-9696
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: GLENN R. GANGI
  • NPI Number: 1043965775
  • Taxonomy: 332900000X - Non-Pharmacy Dispensing Site

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CLIA Record

Field Name Field Value
CLIA Number 42D1074839
LAB Type Physician Office
Facility Name ATLANTIC UROLOGY CLINICS, LLC DBA ADULT & PEDIATRIC UROLOGY
Street 3600 SEA MOUNTAIN HIGHWAY, SUITE B
City LITTLE RIVER
State SC
ZIP 29566
Phone 843 399-9696
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 10/9/2023
Certificate Expiration Date 10/8/2025
Facility Type Physician Office
Lab Director GLENN R. GANGI

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