11D0903572 CLIA NUMBER - PRESTON RIDGE PEDIATRIC ASSOC PC

Laboratory Demographics

  • CLIA Code: 11D0903572
  • Facility Name: PRESTON RIDGE PEDIATRIC ASSOC PC
  • Facility Address: 3400-A OLD MILTON PKWY STE 330
    ALPHARETTA, GA
    ZIP 30005
  • Facility Phone: 770 751-6111
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: REBECCA B. CLEMENTS
  • NPI Number: 1427048685
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D0903572
LAB Type Physician Office
Facility Name PRESTON RIDGE PEDIATRIC ASSOC PC
Street 3400-A OLD MILTON PKWY STE 330
City ALPHARETTA
State GA
ZIP 30005
Phone 770 751-6111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/20/2025
Certificate Expiration Date 9/19/2027
Facility Type Physician Office
Lab Director REBECCA B. CLEMENTS

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