11D0957481 CLIA NUMBER - AGC PEDIATRICS LLC

Laboratory Demographics

  • CLIA Code: 11D0957481
  • Facility Name: AGC PEDIATRICS LLC
  • Facility Address: 204 PROFESSIONAL COURT
    CALHOUN, GA
    ZIP 30701
  • Facility Phone: 706 625-5900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MATTHEW RUMSEY
  • NPI Number: 1851708242
  • Taxonomy: 363LP0200X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 11D0957481
LAB Type Physician Office
Facility Name AGC PEDIATRICS LLC
Street 204 PROFESSIONAL COURT
City CALHOUN
State GA
ZIP 30701
Phone 706 625-5900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/22/2023
Certificate Expiration Date 12/21/2025
Facility Type Physician Office
Lab Director MATTHEW RUMSEY

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