11D0921499 CLIA NUMBER - STOCKBRIDGE PEDIATRICS PC

Laboratory Demographics

  • CLIA Code: 11D0921499
  • Facility Name: STOCKBRIDGE PEDIATRICS PC
  • Facility Address: 239 VILLAGE CENTER PARKWAY SUITE 110
    STOCKBRIDGE, GA
    ZIP 30281
  • Facility Phone: 770 506-0095
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARIXIE Q. LEONOR GILRANE MD
  • NPI Number: 1033374103
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D0921499
LAB Type Physician Office
Facility Name STOCKBRIDGE PEDIATRICS PC
Street 239 VILLAGE CENTER PARKWAY SUITE 110
City STOCKBRIDGE
State GA
ZIP 30281
Phone 770 506-0095
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/17/2024
Certificate Expiration Date 4/16/2026
Facility Type Physician Office
Lab Director MARIXIE Q. LEONOR GILRANE MD

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