11D2270931 CLIA NUMBER - LAWRENCEVILLE CENTER FOR PAIN AND SPINE, LLC

Laboratory Demographics

CLIA Number: 11D2270931

Facility Name: LAWRENCEVILLE CENTER FOR PAIN AND SPINE, LLC

Facility Address:
755 OLD NORCROSS ROAD
LAWRENCEVILLE, GA
ZIP 30046
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Facility Phone Number: 770 771-6580

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1871204511

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2270931
LAB Type	Ambulatory Surgery Center
Facility Name	LAWRENCEVILLE CENTER FOR PAIN AND SPINE, LLC
Street	755 OLD NORCROSS ROAD
City	LAWRENCEVILLE
State	GA
ZIP	30046
Phone	770 771-6580
CertificateType	4
CertificateEffectiveDate	10/25/2022
CertificateExpirationDate	10/24/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024