11D2066004 CLIA NUMBER - CENTER FOR SPINE INTERVENTIONS ASC 1, LLC

Laboratory Demographics

  • CLIA Code: 11D2066004
  • Facility Name: CENTER FOR SPINE INTERVENTIONS ASC 1, LLC
  • Facility Address: 4586 TIMBER RIDGE DRIVE, SUITE 141
    DOUGLASVILLE, GA
    ZIP 30135
  • Facility Phone: 678 813-2741
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: ANANTHA KAMATH
  • NPI Number: 1437407525
  • Taxonomy: 208VP0014X - Pain Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2066004
LAB Type Ambulatory Surgery Center
Facility Name CENTER FOR SPINE INTERVENTIONS ASC 1, LLC
Street 4586 TIMBER RIDGE DRIVE, SUITE 141
City DOUGLASVILLE
State GA
ZIP 30135
Phone 678 813-2741
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/19/2025
Certificate Expiration Date 9/18/2027
Facility Type Ambulatory Surgery Center
Lab Director ANANTHA KAMATH

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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