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CENTURION SURGERY CENTER OF WAYCROSS LLC
NPI 1902653884
Clinic/Center - Ambulatory Surgical in Waycross, GA

Active since April 30, 2024CLIA 11D2310166 · Waiver
1218 ALICE ST STE B, WAYCROSS, GA 31501(912) 590-0973(912) 590-0180 Get Directions Write a Review

NPPES record last updated: July 14, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Centurion Surgery Center Of Waycross Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CENTURION SURGERY CENTER OF WAYCROSS LLC (NPI 1902653884) is a healthcare organization registered as an ambulatory surgical in Waycross, Georgia and active in the NPI registry since April 2024. The organization holds a CLIA Waiver certificate valid through August 27, 2026 and lists Alicia Groth, Credentialing Manager, as its authorized official.

NPPES Registry Identity

NPI1902653884
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameCENTURION SURGERY CENTER OF WAYCROSS LLC
Location Address1218 ALICE ST STE BWaycross, GA 31501-4525
Mailing Address5191 First Coast Tech Pkwy Fl 3Jacksonville, FL 32224-0609 · (904) 223-3321 · Fax (904) 223-2169
Phone(912) 590-0973
Fax(912) 590-0180
Organization SubpartNo
Authorized OfficialAlicia GrothCredentialing Manager · (904) 256-2754
Enumeration DateApril 30, 2024
Last NPPES UpdateJuly 14, 2025
NPPES CertifiedJuly 14, 2025
✔ NPI 1902653884 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
1218 ALICE ST STE B, Waycross, GA 31501
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2310166

Centurion Surgery Center Of Waycross · Waycross, GA
Active · expires Aug 27, 2026
CLIA Number11D2310166
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateAugust 28, 2024
Certificate Expiration DateAugust 27, 2026
Laboratory DirectorKelly Lee
Laboratory Phone(912) 740-2083
Laboratory LocationCenturion Surgery Center Of Waycross1218 Alice Street, Suite B, Waycross, GA 31503
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Centurion Surgery Center Of Waycross LLC's NPI number?

The NPI number for Centurion Surgery Center Of Waycross LLC is 1902653884. It was assigned to this organization in the NPPES registry on April 30, 2024.

Where is Centurion Surgery Center Of Waycross LLC located?

Centurion Surgery Center Of Waycross LLC is located at 1218 Alice St Ste B, Waycross, GA 31501. The listed phone number is (912) 590-0973.

What is Centurion Surgery Center Of Waycross LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Does Centurion Surgery Center Of Waycross LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2310166) is associated with this NPI, valid through August 27, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Centurion Surgery Center Of Waycross LLC was last updated on July 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.