11D0966861 CLIA NUMBER - IM PEDS PRIMARY CARE LLC

Laboratory Demographics

  • CLIA Code: 11D0966861
  • Facility Name: IM PEDS PRIMARY CARE LLC
  • Facility Address: 360 HOSPITAL DRIVE, SUITE 110
    MACON, GA
    ZIP 31217
  • Facility Phone: (478) 464-1340
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: MARY EVELYN MCKINLEY
  • NPI Number: 1578572293
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0966861
LAB Type Physician Office
Facility Name IM PEDS PRIMARY CARE LLC
Street 360 HOSPITAL DRIVE, SUITE 110
City MACON
State GA
ZIP 31217
Phone 4784641340
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 5/18/2025
Certificate Expiration Date 5/17/2027
Facility Type Physician Office
Lab Director MARY EVELYN MCKINLEY

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This page was last updated on: 5/18/2026