11D1019460 CLIA NUMBER - GC DULUTH PEDIATRICS INCORPORATE

Laboratory Demographics

  • CLIA Code: 11D1019460
  • Facility Name: GC DULUTH PEDIATRICS INCORPORATE
  • Facility Address: 3435 DULUTH PARK LANE SUITE A
    DULUTH, GA
    ZIP 30096
  • Facility Phone: 678 417-0407
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SAM H. SONG
  • NPI Number: 1922374297
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D1019460
LAB Type Physician Office
Facility Name GC DULUTH PEDIATRICS INCORPORATE
Street 3435 DULUTH PARK LANE SUITE A
City DULUTH
State GA
ZIP 30096
Phone 678 417-0407
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/19/2023
Certificate Expiration Date 11/18/2025
Facility Type Physician Office
Lab Director SAM H. SONG

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