11D2311457 CLIA NUMBER - ADVANCED SPINE AND PAIN-JASPER

Laboratory Demographics

  • CLIA Code: 11D2311457
  • Facility Name: ADVANCED SPINE AND PAIN-JASPER
  • Facility Address: 49 GORDON ROAD, SUITE 102
    JASPER, GA
    ZIP 30143
  • Facility Phone: 470 299-1998
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: WOODLEY MARDY-DAVIS
  • NPI Number: 1457758450
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2311457
LAB Type Physician Office
Facility Name ADVANCED SPINE AND PAIN-JASPER
Street 49 GORDON ROAD, SUITE 102
City JASPER
State GA
ZIP 30143
Phone 470 299-1998
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/23/2024
Certificate Expiration Date 9/22/2026
Facility Type Physician Office
Lab Director WOODLEY MARDY-DAVIS

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