11D1031385 CLIA NUMBER - COVENANT CARE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 11D1031385
  • Facility Name: COVENANT CARE PEDIATRICS
  • Facility Address: 245 COUNTRY CLUB DRIVE, SUITE 200 A
    STOCKBRIDGE, GA
    ZIP 30281
  • Facility Phone: (770) 389-4543
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PATRICK N. PULLIAM
  • NPI Number: 1902941503
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D1031385
LAB Type Physician Office
Facility Name COVENANT CARE PEDIATRICS
Street 245 COUNTRY CLUB DRIVE, SUITE 200 A
City STOCKBRIDGE
State GA
ZIP 30281
Phone 7703894543
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/29/2024
Certificate Expiration Date 9/28/2026
Facility Type Physician Office
Lab Director PATRICK N. PULLIAM

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This page was last updated on: 5/18/2026