11D0975633 CLIA NUMBER - PEDIATRICS AND ADOLESCENT MEDICINE

Laboratory Demographics

  • CLIA Code: 11D0975633
  • Facility Name: PEDIATRICS AND ADOLESCENT MEDICINE
  • Facility Address: 11755 POINTE PLACE, SUITE C
    ROSWELL, GA
    ZIP 30076
  • Facility Phone: 770 740-0601
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JULIA WORLY
  • NPI Number: 1902433832
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D0975633
LAB Type Physician Office
Facility Name PEDIATRICS AND ADOLESCENT MEDICINE
Street 11755 POINTE PLACE, SUITE C
City ROSWELL
State GA
ZIP 30076
Phone 770 740-0601
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/12/2024
Certificate Expiration Date 7/11/2026
Facility Type Physician Office
Lab Director JULIA WORLY

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