11D2100365 CLIA NUMBER - SOUTHEASTERN INTERVENTIONAL PAIN ASC

Laboratory Demographics

  • CLIA Code: 11D2100365
  • Facility Name: SOUTHEASTERN INTERVENTIONAL PAIN ASC
  • Facility Address: 1150 HAMMOND DRIVE BUILDING E, SUITE 50
    ATLANTA, GA
    ZIP 30328
  • Facility Phone: 770 558-8501
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: ANKUR B. PATEL
  • NPI Number: 1588992069
  • Taxonomy: 207LP2900X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 11D2100365
LAB Type Ambulatory Surgery Center
Facility Name SOUTHEASTERN INTERVENTIONAL PAIN ASC
Street 1150 HAMMOND DRIVE BUILDING E, SUITE 50
City ATLANTA
State GA
ZIP 30328
Phone 770 558-8501
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/13/2025
Certificate Expiration Date 8/12/2027
Facility Type Ambulatory Surgery Center
Lab Director ANKUR B. PATEL

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