11D2192321 CLIA NUMBER - REGENERATIVE SPINE AND PAIN SPECIALISTS

Laboratory Demographics

  • CLIA Code: 11D2192321
  • Facility Name: REGENERATIVE SPINE AND PAIN SPECIALISTS
  • Facility Address: 874 W LANIER AVENUE SUITE 250
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 770 597-1546
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: DR. EVAN S. HOLZBERG
  • NPI Number: 1558853085
  • Taxonomy: 2251X0800X - Physical Therapist

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CLIA Record

Field Name Field Value
CLIA Number 11D2192321
LAB Type Physician Office
Facility Name REGENERATIVE SPINE AND PAIN SPECIALISTS
Street 874 W LANIER AVENUE SUITE 250
City FAYETTEVILLE
State GA
ZIP 30214
Phone 770 597-1546
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 9/27/2024
Certificate Expiration Date 9/26/2026
Facility Type Physician Office
Lab Director DR. EVAN S. HOLZBERG

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