11D1076331 CLIA NUMBER - PAVILION SPINE SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 11D1076331
  • Facility Name: PAVILION SPINE SURGERY CENTER
  • Facility Address: 3193 HOWELL MILL ROAD SUITE 315
    ATLANTA, GA
    ZIP 30327
  • Facility Phone: 404 603-9090
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: KAMAL C. KABAKIBOU MD
  • NPI Number: 1548459860
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1076331
LAB Type Ambulatory Surgery Center
Facility Name PAVILION SPINE SURGERY CENTER
Street 3193 HOWELL MILL ROAD SUITE 315
City ATLANTA
State GA
ZIP 30327
Phone 404 603-9090
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/13/2023
Certificate Expiration Date 11/12/2025
Facility Type Ambulatory Surgery Center
Lab Director KAMAL C. KABAKIBOU MD

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