11D2164526 CLIA NUMBER - GEORGIA INTERVENTIONAL PAIN E, LLC

Laboratory Demographics

  • CLIA Code: 11D2164526
  • Facility Name: GEORGIA INTERVENTIONAL PAIN E, LLC
  • Facility Address: 100 LIBERTY BLVD, SUITE 200
    CANTON, GA
    ZIP 30114
  • Facility Phone: 770 962-3642
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: AMIT S. PATEL
  • NPI Number: 1700424322
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2164526
LAB Type Ambulatory Surgery Center
Facility Name GEORGIA INTERVENTIONAL PAIN E, LLC
Street 100 LIBERTY BLVD, SUITE 200
City CANTON
State GA
ZIP 30114
Phone 770 962-3642
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/9/2025
Certificate Expiration Date 4/8/2027
Facility Type Ambulatory Surgery Center
Lab Director AMIT S. PATEL

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