11D0921567 CLIA NUMBER - KIDCARE PEDIATRICS LLC

Laboratory Demographics

  • CLIA Code: 11D0921567
  • Facility Name: KIDCARE PEDIATRICS LLC
  • Facility Address: 2565 JOLLY ROAD, SUITE A & B
    COLLEGE PARK, GA
    ZIP 30349
  • Facility Phone: 404 691-6100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HELENA BENTLEY MD
  • NPI Number: 1417044181
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D0921567
LAB Type Physician Office
Facility Name KIDCARE PEDIATRICS LLC
Street 2565 JOLLY ROAD, SUITE A & B
City COLLEGE PARK
State GA
ZIP 30349
Phone 404 691-6100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/12/2025
Certificate Expiration Date 2/11/2027
Facility Type Physician Office
Lab Director HELENA BENTLEY MD

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