11D0912305 CLIA NUMBER - LAKESIDE PEDIATRIC LLC

Laboratory Demographics

  • CLIA Code: 11D0912305
  • Facility Name: LAKESIDE PEDIATRIC LLC
  • Facility Address: 204 CANTON HIGHWAY
    CUMMING, GA
    ZIP 30040
  • Facility Phone: 770 886-5437
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BOB B. BAGHERI MD
  • NPI Number: 1326317520
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D0912305
LAB Type Physician Office
Facility Name LAKESIDE PEDIATRIC LLC
Street 204 CANTON HIGHWAY
City CUMMING
State GA
ZIP 30040
Phone 770 886-5437
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/29/2024
Certificate Expiration Date 2/27/2026
Facility Type Physician Office
Lab Director BOB B. BAGHERI MD

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