11D0707369 CLIA NUMBER - WELLSTAR CREEKSIDE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 11D0707369
  • Facility Name: WELLSTAR CREEKSIDE PEDIATRICS
  • Facility Address: 6095 PROFESSIONAL PARKWAY, SUITE 100
    DOUGLASVILLE, GA
    ZIP 30134
  • Facility Phone: 770 920-2255
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ETHESHAMUL HUQUE
  • NPI Number: 1346296837
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D0707369
LAB Type Physician Office
Facility Name WELLSTAR CREEKSIDE PEDIATRICS
Street 6095 PROFESSIONAL PARKWAY, SUITE 100
City DOUGLASVILLE
State GA
ZIP 30134
Phone 770 920-2255
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/14/2024
Certificate Expiration Date 9/13/2026
Facility Type Physician Office
Lab Director ETHESHAMUL HUQUE

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