11D0994179 CLIA NUMBER - DV PEDIATRICS

Laboratory Demographics

  • CLIA Code: 11D0994179
  • Facility Name: DV PEDIATRICS
  • Facility Address: 2929 MARIETTA HIGHWAY SUITE 142
    CANTON, GA
    ZIP 30114
  • Facility Phone: 770 704-6331
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: VICKI D. KNIGHT MATHIS
  • NPI Number: 1346368149
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0994179
LAB Type Physician Office
Facility Name DV PEDIATRICS
Street 2929 MARIETTA HIGHWAY SUITE 142
City CANTON
State GA
ZIP 30114
Phone 770 704-6331
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/26/2025
Certificate Expiration Date 9/25/2027
Facility Type Physician Office
Lab Director VICKI D. KNIGHT MATHIS

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