11D1085729 CLIA NUMBER - LAKESIDE PAIN CENTER PC

Laboratory Demographics

  • CLIA Code: 11D1085729
  • Facility Name: LAKESIDE PAIN CENTER PC
  • Facility Address: 125 PLANTATION CENTRE DRIVE S, SUITE 750A
    MACON, GA
    ZIP 31210
  • Facility Phone: 478 475-9220
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DWAYNE L. CLAY
  • NPI Number: 1477566727
  • Taxonomy: 208VP0014X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1085729
LAB Type Physician Office
Facility Name LAKESIDE PAIN CENTER PC
Street 125 PLANTATION CENTRE DRIVE S, SUITE 750A
City MACON
State GA
ZIP 31210
Phone 478 475-9220
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/25/2024
Certificate Expiration Date 6/24/2026
Facility Type Physician Office
Lab Director DWAYNE L. CLAY

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