11D0966273 CLIA NUMBER - SUWANEE PEDIATRICS LLC

Laboratory Demographics

  • CLIA Code: 11D0966273
  • Facility Name: SUWANEE PEDIATRICS LLC
  • Facility Address: 1155 LAWRENCEVILLE-SUWANEE ROAD
    LAWRENCEVILLE, GA
    ZIP 30043
  • Facility Phone: 678 442-0205
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BOLAJI T. ODUSINA MD
  • NPI Number: 1487886123
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0966273
LAB Type Physician Office
Facility Name SUWANEE PEDIATRICS LLC
Street 1155 LAWRENCEVILLE-SUWANEE ROAD
City LAWRENCEVILLE
State GA
ZIP 30043
Phone 678 442-0205
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/12/2025
Certificate Expiration Date 10/11/2027
Facility Type Physician Office
Lab Director BOLAJI T. ODUSINA MD

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