CLIA lab
CLIA 11D1094704: Georgia Urology Fayette Ambulatory Surgery Center
Fayetteville, GA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 11D1094704 belongs to Georgia Urology Fayette Ambulatory Surgery Center in Fayetteville, GA.
Certificate of Waiver, effective March 27, 2026, expires March 26, 2028.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- March 27, 2026
- Certificate expiration
- March 26, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- January 26, 2009
- Facility type
- Physician office
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 11D1094704
- Lab name
- Georgia Urology Fayette Ambulatory Surgery Center
- Address
- 1336 Hwy 54W Bldg 100 Suite 101, Fayetteville, GA 30214
- Phone
- (678) 610-3395
- Fax
- (678) 610-3462
Annual test volume the lab reported
- Waived tests
- 1,500
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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Related
Questions
What is the CLIA number for Georgia Urology Fayette Ambulatory Surgery Center in Fayetteville?
11D1094704, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Georgia Urology Fayette Ambulatory Surgery Center hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 11D1094704 expire?
The CMS file lists March 26, 2028 as the certificate expiration date; the certificate took effect March 27, 2026.