11D0989925 CLIA NUMBER - SUGARLOAF PEDIATRICS PC

Laboratory Demographics

  • CLIA Code: 11D0989925
  • Facility Name: SUGARLOAF PEDIATRICS PC
  • Facility Address: 4095 SUGARLOAF PARKWAY
    LAWRENCEVILLE, GA
    ZIP 30044
  • Facility Phone: 678 377-1113
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUSAMMA MATHEW
  • NPI Number: 1134297799
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0989925
LAB Type Physician Office
Facility Name SUGARLOAF PEDIATRICS PC
Street 4095 SUGARLOAF PARKWAY
City LAWRENCEVILLE
State GA
ZIP 30044
Phone 678 377-1113
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/9/2025
Certificate Expiration Date 8/8/2027
Facility Type Physician Office
Lab Director SUSAMMA MATHEW

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