11D1040575 CLIA NUMBER - GEORGIA PAIN SPINE CENTER LLC

Laboratory Demographics

  • CLIA Code: 11D1040575
  • Facility Name: GEORGIA PAIN SPINE CENTER LLC
  • Facility Address: 15 MEDICAL DRIVE, SUITE 302
    CARTERSVILLE, GA
    ZIP 30121
  • Facility Phone: 770 590-1078
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DAVID W. GALE
  • NPI Number: 1154473858
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 11D1040575
LAB Type Ambulatory Surgery Center
Facility Name GEORGIA PAIN SPINE CENTER LLC
Street 15 MEDICAL DRIVE, SUITE 302
City CARTERSVILLE
State GA
ZIP 30121
Phone 770 590-1078
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2025
Certificate Expiration Date 5/11/2027
Facility Type Ambulatory Surgery Center
Lab Director DAVID W. GALE

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