11D0909369 CLIA NUMBER - WESTSIDE PEDIATRICS PC

Laboratory Demographics

  • CLIA Code: 11D0909369
  • Facility Name: WESTSIDE PEDIATRICS PC
  • Facility Address: 6084 PROFESSIONAL PARKWAY SUITE A
    DOUGLASVILLE, GA
    ZIP 30134
  • Facility Phone: 770 920-0085
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RAJU J. KULANGARA
  • NPI Number: 1104049519
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D0909369
LAB Type Physician Office
Facility Name WESTSIDE PEDIATRICS PC
Street 6084 PROFESSIONAL PARKWAY SUITE A
City DOUGLASVILLE
State GA
ZIP 30134
Phone 770 920-0085
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/4/2023
Certificate Expiration Date 12/3/2025
Facility Type Physician Office
Lab Director RAJU J. KULANGARA

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