CLIA lab
CLIA 11D2004903: Carrollton Surgical Group
Villa Rica, GA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 11D2004903 belongs to Carrollton Surgical Group in Villa Rica, GA.
Certificate of Waiver, effective March 16, 2026, expires March 15, 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 16, 2026
- Certificate expiration
- March 15, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- March 16, 2010
- Facility type
- Physician office
- Ownership (control type)
- Other
- Lab classification
- CLIA laboratory
- Directly affiliated labs
- 2
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 11D2004903
- Lab name
- Carrollton Surgical Group
- Address
- 690 Dallas Highway, Suite 207, Villa Rica, GA 30180
- Phone
- (770) 456-3646
- Fax
- (770) 456-3647
Annual test volume the lab reported
- Waived tests
- 12
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Affiliated CLIA numbers
Other labs in Villa Rica, GA
- 3 16 Healthcare-Family Medicine & Kids CornerCertificate of Waiver, Physician office11D2327810
- Agape Hospice Care of Carollton, LLCCertificate of Waiver, Hospice11D2044565
- Altus Hospice of Georgia, LLCCertificate of Waiver, Hospice11D1076785
- Angel Heart Hospice DBA Family HospiceCertificate of Waiver, Hospice11D2195353
- BJK Specimen LLCCertificate of Waiver, Other practitioner11D2345847
- Bio Medical Applications of Georgia IncorporatedCertificate of Waiver, End stage renal disease dialysis facility11D1054047
- Carroll County Nephrology PCCertificate of Waiver, Physician office11D1093957
- Center for Allergy and Asthma of WestCertificate of Waiver, Physician office11D1009377
- Chattahoochee Healthcare LLCCertificate of Waiver, Physician office11D0950002
- Childrens Healthcare of West Georgia - Villa RicaCertificate of Waiver, Physician office11D1044645
Related
Questions
What is the CLIA number for Carrollton Surgical Group in Villa Rica?
11D2004903, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Carrollton Surgical Group hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 11D2004903 expire?
The CMS file lists March 15, 2028 as the certificate expiration date; the certificate took effect March 16, 2026.