11D2084142 CLIA NUMBER - PCA INTERVENTIONAL SPINE AT MACQUARIUM, LLC

Laboratory Demographics

  • CLIA Code: 11D2084142
  • Facility Name: PCA INTERVENTIONAL SPINE AT MACQUARIUM, LLC
  • Facility Address: 1800 PEACHTREE STREET SUITE 775
    ATLANTA, GA
    ZIP 30309
  • Facility Phone: 404 351-7654
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: RODRIGO DURALDE
  • NPI Number: 1053719393
  • Taxonomy: 261QP3300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2084142
LAB Type Ambulatory Surgery Center
Facility Name PCA INTERVENTIONAL SPINE AT MACQUARIUM, LLC
Street 1800 PEACHTREE STREET SUITE 775
City ATLANTA
State GA
ZIP 30309
Phone 404 351-7654
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/25/2024
Certificate Expiration Date 11/24/2026
Facility Type Ambulatory Surgery Center
Lab Director RODRIGO DURALDE

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This page was last updated on: 3/20/2025