11D0985933 CLIA NUMBER - WOODSTOCK PEDIATRICS PC DBA MAIN STREET PEDIATRICS

Laboratory Demographics

  • CLIA Code: 11D0985933
  • Facility Name: WOODSTOCK PEDIATRICS PC DBA MAIN STREET PEDIATRICS
  • Facility Address: 460 WEST MAIN STREET, SUITE 100
    BLUE RIDGE, GA
    ZIP 30513
  • Facility Phone: 706 632-0330
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KIMBERLY T. WILLIAMS
  • NPI Number: 1104159086
  • Taxonomy: 208000000X - Pediatrics

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D0985933
LAB Type Physician Office
Facility Name WOODSTOCK PEDIATRICS PC DBA MAIN STREET PEDIATRICS
Street 460 WEST MAIN STREET, SUITE 100
City BLUE RIDGE
State GA
ZIP 30513
Phone 706 632-0330
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/2/2025
Certificate Expiration Date 5/1/2027
Facility Type Physician Office
Lab Director KIMBERLY T. WILLIAMS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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