11D2091367 CLIA NUMBER - SELECT INTERVENTIONAL PAIN, PC

Laboratory Demographics

  • CLIA Code: 11D2091367
  • Facility Name: SELECT INTERVENTIONAL PAIN, PC
  • Facility Address: 794 MCDONOUGH ROAD, SUITE 108
    JACKSON, GA
    ZIP 30233
  • Facility Phone: 470 251-5300
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: LISA CICHON
  • NPI Number: 1750789947
  • Taxonomy: 208VP0014X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2091367
LAB Type Physician Office
Facility Name SELECT INTERVENTIONAL PAIN, PC
Street 794 MCDONOUGH ROAD, SUITE 108
City JACKSON
State GA
ZIP 30233
Phone 470 251-5300
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 8/21/2024
Certificate Expiration Date 8/20/2026
Facility Type Physician Office
Lab Director LISA CICHON

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