PREMIER SURGICAL PAVILION OF ATLANTA LLC
NPI 1104301274
Clinic/Center - Ambulatory Surgical in Atlanta, GA

Q: What is Premier Surgical Pavilion Of Atlanta LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Active since September 25, 2018CLIA 11D0977113 · Waiver

1 BALTIMORE PL NW STE 400, ATLANTA, GA 30308(212) 223-0716 Get Directions Write a Review

NPPES record last updated: September 25, 2018. Verified against the NPPES registry weekly; last sync: July 26, 2026.

On this page

About Premier Surgical Pavilion Of Atlanta Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PREMIER SURGICAL PAVILION OF ATLANTA LLC (NPI 1104301274) is a healthcare organization registered as an ambulatory surgical in Atlanta, Georgia and active in the NPI registry since September 2018. The organization holds a CLIA Waiver certificate valid through August 21, 2026 and lists Michael E Jones, Owner, as its authorized official.

NPPES Registry Identity

NPI1104301274

Entity TypeOrganization

Primary Taxonomy261QA1903X

Legal Business NamePREMIER SURGICAL PAVILION OF ATLANTA LLC

Location Address1 BALTIMORE PL NW STE 400Atlanta, GA 30308-2117

Mailing AddressPo Box 1970New York, NY 10156-1970 · (212) 223-0716

Phone(212) 223-0716

Organization SubpartNo

Authorized OfficialMichael E JonesOwner · (212) 223-0716

Enumeration DateSeptember 25, 2018

✔ NPI 1104301274 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities

Taxonomy Code261QA1903X

1 BALTIMORE PL NW STE 400, Atlanta, GA 30308

Open in Google Maps ↗

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D0977113

Premier Surgical Pavilion Of Atlanta · Atlanta, GA

Active · expires Aug 21, 2026

CLIA Number11D0977113

Laboratory TypeAmbulatory Surgery Center

Certificate Effective DateAugust 22, 2024

Certificate Expiration DateAugust 21, 2026

Laboratory DirectorMichael E. Jones

Laboratory Phone(404) 410-0942

Laboratory LocationPremier Surgical Pavilion Of Atlanta1 Baltimore Place, Suite 400, Atlanta, GA 30308

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Leave this field empty

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ATLANTA AESTHETIC AND RECONSTRUCTIVE SURGERY CENTER, LLC

Clinic/Center (Ambulatory Surgical)