11D2021186 CLIA NUMBER - CARROLLTON ORTHOPAEDIC CLINIC SPINE AND MRI CTR

Laboratory Demographics

  • CLIA Code: 11D2021186
  • Facility Name: CARROLLTON ORTHOPAEDIC CLINIC SPINE AND MRI CTR
  • Facility Address: 812 SOUTH PARK STREET, SUITE 3
    CARROLLTON, GA
    ZIP 30117
  • Facility Phone: 770 834-0873
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: E FRANKLIN PENCE
  • NPI Number: 1255434221
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2021186
LAB Type Physician Office
Facility Name CARROLLTON ORTHOPAEDIC CLINIC SPINE AND MRI CTR
Street 812 SOUTH PARK STREET, SUITE 3
City CARROLLTON
State GA
ZIP 30117
Phone 770 834-0873
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/8/2025
Certificate Expiration Date 3/7/2027
Facility Type Physician Office
Lab Director E FRANKLIN PENCE

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