11D1025627 CLIA NUMBER - PEDIATRIC PHYSICIAN PC

Laboratory Demographics

  • CLIA Code: 11D1025627
  • Facility Name: PEDIATRIC PHYSICIAN PC
  • Facility Address: 11050 CRABAPPLE ROAD, SUITE 120
    ROSWELL, GA
    ZIP 30075
  • Facility Phone: 770 518-9277
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STANTON STEBBINS
  • NPI Number: 1285768184
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1025627
LAB Type Physician Office
Facility Name PEDIATRIC PHYSICIAN PC
Street 11050 CRABAPPLE ROAD, SUITE 120
City ROSWELL
State GA
ZIP 30075
Phone 770 518-9277
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2024
Certificate Expiration Date 5/11/2026
Facility Type Physician Office
Lab Director STANTON STEBBINS

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