11D1035620 CLIA NUMBER - COLUMBUS CHILDRENS CLINIC, LLC

Laboratory Demographics

  • CLIA Code: 11D1035620
  • Facility Name: COLUMBUS CHILDRENS CLINIC, LLC
  • Facility Address: 1546 10TH AVE STE A
    COLUMBUS, GA
    ZIP 31901
  • Facility Phone: 706 322-5526
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LIRIO E. PALMOS
  • NPI Number: 1619430410
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D1035620
LAB Type Physician Office
Facility Name COLUMBUS CHILDRENS CLINIC, LLC
Street 1546 10TH AVE STE A
City COLUMBUS
State GA
ZIP 31901
Phone 706 322-5526
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/6/2025
Certificate Expiration Date 1/5/2027
Facility Type Physician Office
Lab Director LIRIO E. PALMOS

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