11D0989925 CLIA NUMBER - SUGARLOAF PEDIATRICS PC

Laboratory Demographics

CLIA Number: 11D0989925

Facility Name: SUGARLOAF PEDIATRICS PC

Facility Address:
3525 SUGARLOAF PARKWAY
LAWRENCEVILLE, GA
ZIP 30044
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Facility Phone Number: 678 377-1113

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1134297799

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D0989925
LAB Type	Physician Office
Facility Name	SUGARLOAF PEDIATRICS PC
Street	3525 SUGARLOAF PARKWAY
City	LAWRENCEVILLE
State	GA
ZIP	30044
Phone	678 377-1113
CertificateType	4
CertificateEffectiveDate	8/9/2023
CertificateExpirationDate	8/8/2025
FacilityType	Waiver

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