11D2189017 CLIA NUMBER - LASER SPINE AND PAIN CENTERS PRADO, LLC

Laboratory Demographics

  • CLIA Code: 11D2189017
  • Facility Name: LASER SPINE AND PAIN CENTERS PRADO, LLC
  • Facility Address: 5505 ROSWELL ROAD SUITE 350 #B
    ATLANTA, GA
    ZIP 30342
  • Facility Phone: 770 627-7246
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: V K PUPPULA
  • NPI Number: 1346763190
  • Taxonomy: 261QP3300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2189017
LAB Type Ambulatory Surgery Center
Facility Name LASER SPINE AND PAIN CENTERS PRADO, LLC
Street 5505 ROSWELL ROAD SUITE 350 #B
City ATLANTA
State GA
ZIP 30342
Phone 770 627-7246
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/24/2024
Certificate Expiration Date 7/23/2026
Facility Type Ambulatory Surgery Center
Lab Director V K PUPPULA

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