11D2221358 CLIA NUMBER - INTERVENTIONAL PAIN INSTITUTE LLC

Laboratory Demographics

  • CLIA Code: 11D2221358
  • Facility Name: INTERVENTIONAL PAIN INSTITUTE LLC
  • Facility Address: 3200 GILLIONVILLE ROAD
    ALBANY, GA
    ZIP 31721
  • Facility Phone: (229) 405-2470
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: W MICHAEL FUSSELL
  • NPI Number: 1508444837
  • Taxonomy: 208VP0014X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2221358
LAB Type Physician Office
Facility Name INTERVENTIONAL PAIN INSTITUTE LLC
Street 3200 GILLIONVILLE ROAD
City ALBANY
State GA
ZIP 31721
Phone 2294052470
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/21/2025
Certificate Expiration Date 4/20/2027
Facility Type Physician Office
Lab Director W MICHAEL FUSSELL

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This page was last updated on: 5/15/2026