11D0969638 CLIA NUMBER - MOUNTAINSIDE PEDIATRICS LLC

Laboratory Demographics

  • CLIA Code: 11D0969638
  • Facility Name: MOUNTAINSIDE PEDIATRICS LLC
  • Facility Address: 12 SAMMY MCGHEE BOULEVARD, SUITE 102
    JASPER, GA
    ZIP 30143
  • Facility Phone: 706 253-9898
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KHAWAJA R. MAHMOOD
  • NPI Number: 1710267505
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0969638
LAB Type Physician Office
Facility Name MOUNTAINSIDE PEDIATRICS LLC
Street 12 SAMMY MCGHEE BOULEVARD, SUITE 102
City JASPER
State GA
ZIP 30143
Phone 706 253-9898
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/21/2024
Certificate Expiration Date 1/20/2026
Facility Type Physician Office
Lab Director KHAWAJA R. MAHMOOD

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