11D0918374 CLIA NUMBER - DEKALB PEDIATRIC CENTER PC

Laboratory Demographics

  • CLIA Code: 11D0918374
  • Facility Name: DEKALB PEDIATRIC CENTER PC
  • Facility Address: 350 WINN WAY
    DECATUR, GA
    ZIP 30030
  • Facility Phone: 404 508-1177
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MELINDA A. WILLINGHAM
  • NPI Number: 1164695458
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D0918374
LAB Type Physician Office
Facility Name DEKALB PEDIATRIC CENTER PC
Street 350 WINN WAY
City DECATUR
State GA
ZIP 30030
Phone 404 508-1177
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/7/2024
Certificate Expiration Date 8/6/2026
Facility Type Physician Office
Lab Director MELINDA A. WILLINGHAM

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