11D2212405 CLIA NUMBER - GEORGIA INTERVENTIONAL PAIN H, LLC

Laboratory Demographics

  • CLIA Code: 11D2212405
  • Facility Name: GEORGIA INTERVENTIONAL PAIN H, LLC
  • Facility Address: 526 BANKHEAD HIGHWAY, SUITE 102
    CARROLLTON, GA
    ZIP 30117
  • Facility Phone: 770 962-3642
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: AMIT S. PATEL
  • NPI Number: 1114552338
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2212405
LAB Type Ambulatory Surgery Center
Facility Name GEORGIA INTERVENTIONAL PAIN H, LLC
Street 526 BANKHEAD HIGHWAY, SUITE 102
City CARROLLTON
State GA
ZIP 30117
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 2/4/2025
Certificate Expiration Date 2/3/2027
Facility Type Ambulatory Surgery Center
Lab Director AMIT S. PATEL

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