11D2192202 CLIA NUMBER - FX SPINE AND PERFORMANCE CENTER, LLC

Laboratory Demographics

  • CLIA Code: 11D2192202
  • Facility Name: FX SPINE AND PERFORMANCE CENTER, LLC
  • Facility Address: 106 SRP DRIVE, SUITE B
    EVANS, GA
    ZIP 30809
  • Facility Phone: 706 842-6800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NICHOLAS A. DEANGELO
  • NPI Number: 1558970640
  • Taxonomy: 207LP2900X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 11D2192202
LAB Type Physician Office
Facility Name FX SPINE AND PERFORMANCE CENTER, LLC
Street 106 SRP DRIVE, SUITE B
City EVANS
State GA
ZIP 30809
Phone 706 842-6800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/8/2024
Certificate Expiration Date 9/7/2026
Facility Type Physician Office
Lab Director NICHOLAS A. DEANGELO

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