11D2310420 CLIA NUMBER - GEORGIA INTERVENTIONAL PAIN - Q, LLC

Laboratory Demographics

  • CLIA Code: 11D2310420
  • Facility Name: GEORGIA INTERVENTIONAL PAIN - Q, LLC
  • Facility Address: 5670 OLD WINDER HIGHWAY, SUITE 104
    BRASELTON, GA
    ZIP 30517
  • Facility Phone: 770 962-3642
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: AMIT S. PATEL
  • NPI Number: 1164274601
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2310420
LAB Type Ambulatory Surgery Center
Facility Name GEORGIA INTERVENTIONAL PAIN - Q, LLC
Street 5670 OLD WINDER HIGHWAY, SUITE 104
City BRASELTON
State GA
ZIP 30517
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 9/4/2024
Certificate Expiration Date 9/3/2026
Facility Type Ambulatory Surgery Center
Lab Director AMIT S. PATEL

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