11D0665768 CLIA NUMBER - PEDIATRIC PARTNERS OF GWINNETT

Laboratory Demographics

  • CLIA Code: 11D0665768
  • Facility Name: PEDIATRIC PARTNERS OF GWINNETT
  • Facility Address: 1567 MILSTEAD ROAD, SUITE B
    CONYERS, GA
    ZIP 30012
  • Facility Phone: 770 923-6400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GEORGE KATSITADZE
  • NPI Number: 1467613232
  • Taxonomy: 2080P0202X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D0665768
LAB Type Physician Office
Facility Name PEDIATRIC PARTNERS OF GWINNETT
Street 1567 MILSTEAD ROAD, SUITE B
City CONYERS
State GA
ZIP 30012
Phone 770 923-6400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/20/2023
Certificate Expiration Date 12/19/2025
Facility Type Physician Office
Lab Director GEORGE KATSITADZE

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