11D2095245 CLIA NUMBER - ADVANCED SPINE & PAIN INTERVENTIONS, LLC

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Laboratory Demographics

CLIA Number: 11D2095245

Facility Name: ADVANCED SPINE & PAIN INTERVENTIONS, LLC

Facility Address:
12389 CRABAPPLE ROAD
ALPHARETTA, GA
ZIP 30004
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Facility Phone Number: 470 299-1998

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1457758450

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2095245
LAB Type	Physician Office
Facility Name	ADVANCED SPINE & PAIN INTERVENTIONS, LLC
Street	12389 CRABAPPLE ROAD
City	ALPHARETTA
State	GA
ZIP	30004
Phone	470 299-1998
CertificateType	4
CertificateEffectiveDate	5/3/2023
CertificateExpirationDate	5/2/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024