11D1009382 CLIA NUMBER - VPC INCORPORATE DBA VIDALIA PEDIATRIC CLINIC

Laboratory Demographics

  • CLIA Code: 11D1009382
  • Facility Name: VPC INCORPORATE DBA VIDALIA PEDIATRIC CLINIC
  • Facility Address: 303 HARRIS INDUSTRIAL BOULEVARD, SUITE 3
    VIDALIA, GA
    ZIP 30474
  • Facility Phone: 912 537-9355
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. ETTA W. BOSS - COLE
  • NPI Number: 1710043237
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D1009382
LAB Type Physician Office
Facility Name VPC INCORPORATE DBA VIDALIA PEDIATRIC CLINIC
Street 303 HARRIS INDUSTRIAL BOULEVARD, SUITE 3
City VIDALIA
State GA
ZIP 30474
Phone 912 537-9355
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/15/2024
Certificate Expiration Date 4/14/2026
Facility Type Physician Office
Lab Director DR. ETTA W. BOSS - COLE

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