11D1031340 CLIA NUMBER - LOCUST GROVE PEDIATRICS LLC

Laboratory Demographics

  • CLIA Code: 11D1031340
  • Facility Name: LOCUST GROVE PEDIATRICS LLC
  • Facility Address: 5040 BILL GARDNER PARKWAY, SUITE 100
    LOCUST GROVE, GA
    ZIP 30248
  • Facility Phone: 678 583-5437
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: DR. JOHN F. MYNATT JR
  • NPI Number: 1174693519
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D1031340
LAB Type Physician Office
Facility Name LOCUST GROVE PEDIATRICS LLC
Street 5040 BILL GARDNER PARKWAY, SUITE 100
City LOCUST GROVE
State GA
ZIP 30248
Phone 678 583-5437
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 2/13/2025
Certificate Expiration Date 2/12/2027
Facility Type Physician Office
Lab Director DR. JOHN F. MYNATT JR

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