11D1022388 CLIA NUMBER - DAHLONEGA PEDIATRIC AND ADOLESCENT MED

Laboratory Demographics

CLIA Number: 11D1022388

Facility Name: DAHLONEGA PEDIATRIC AND ADOLESCENT MED

Facility Address:
1055 NORTH GROVE STREET
DAHLONEGA, GA
ZIP 30533
Get Directions

Facility Phone Number: 706 864-6700

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1922127851

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D1022388
LAB Type	Physician Office
Facility Name	DAHLONEGA PEDIATRIC AND ADOLESCENT MED
Street	1055 NORTH GROVE STREET
City	DAHLONEGA
State	GA
ZIP	30533
Phone	706 864-6700
CertificateType	4
CertificateEffectiveDate	2/16/2024
CertificateExpirationDate	2/15/2026
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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