11D0937556 CLIA NUMBER - ABC PEDIATRICS PC

Laboratory Demographics

  • CLIA Code: 11D0937556
  • Facility Name: ABC PEDIATRICS PC
  • Facility Address: 735 GLYNN STREET, SOUTH
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 770 461-4126
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMIE F. WALLACE
  • NPI Number: 1902923964
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D0937556
LAB Type Physician Office
Facility Name ABC PEDIATRICS PC
Street 735 GLYNN STREET, SOUTH
City FAYETTEVILLE
State GA
ZIP 30214
Phone 770 461-4126
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/1/2024
Certificate Expiration Date 7/31/2026
Facility Type Physician Office
Lab Director JAMIE F. WALLACE

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