11D1090508 CLIA NUMBER - PHYSICIAN PAIN CARE PC

Laboratory Demographics

  • CLIA Code: 11D1090508
  • Facility Name: PHYSICIAN PAIN CARE PC
  • Facility Address: 240 HERITAGE WALK
    WOODSTOCK, GA
    ZIP 30188
  • Facility Phone: 770 516-7880
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: JEFFERY RUBIN
  • NPI Number: 1023273570
  • Taxonomy: 261QP3300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1090508
LAB Type Physician Office
Facility Name PHYSICIAN PAIN CARE PC
Street 240 HERITAGE WALK
City WOODSTOCK
State GA
ZIP 30188
Phone 770 516-7880
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 2/8/2025
Certificate Expiration Date 2/7/2027
Facility Type Physician Office
Lab Director JEFFERY RUBIN

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