11D1000617 CLIA NUMBER - PEDIATRICS VILLAGE PC

Laboratory Demographics

  • CLIA Code: 11D1000617
  • Facility Name: PEDIATRICS VILLAGE PC
  • Facility Address: 375 HIGHWAY 74 NORTH
    PEACHTREE CITY, GA
    ZIP 30269
  • Facility Phone: 770 487-4003
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: W STEEN JAMES
  • NPI Number: 1427217322
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D1000617
LAB Type Physician Office
Facility Name PEDIATRICS VILLAGE PC
Street 375 HIGHWAY 74 NORTH
City PEACHTREE CITY
State GA
ZIP 30269
Phone 770 487-4003
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/19/2024
Certificate Expiration Date 6/18/2026
Facility Type Physician Office
Lab Director W STEEN JAMES

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