11D0977717 CLIA NUMBER - CHILDRENS CARE PEDIATRICS

Laboratory Demographics

CLIA Number: 11D0977717

Facility Name: CHILDRENS CARE PEDIATRICS

Facility Address:
5445 MERIDIAN MARK RD SUITE 380
ATLANTA, GA
ZIP 30342
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Facility Phone Number: 404 845-1261

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1073886370

Taxonomy: 363LP0200X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	11D0977717
LAB Type	Physician Office
Facility Name	CHILDRENS CARE PEDIATRICS
Street	5445 MERIDIAN MARK RD SUITE 380
City	ATLANTA
State	GA
ZIP	30342
Phone	404 845-1261
CertificateType	4
CertificateEffectiveDate	9/5/2022
CertificateExpirationDate	9/4/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024