11D1043236 CLIA NUMBER - VICKERY PEDIATRICS, LLC

Laboratory Demographics

  • CLIA Code: 11D1043236
  • Facility Name: VICKERY PEDIATRICS, LLC
  • Facility Address: 410 PEACHTREE PARKWAY, SUITE 4260
    CUMMING, GA
    ZIP 30041
  • Facility Phone: 678 990-2505
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GWENDOLYN A. DELANEY MD
  • NPI Number: 1639297401
  • Taxonomy: 2080A0000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D1043236
LAB Type Physician Office
Facility Name VICKERY PEDIATRICS, LLC
Street 410 PEACHTREE PARKWAY, SUITE 4260
City CUMMING
State GA
ZIP 30041
Phone 678 990-2505
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/25/2025
Certificate Expiration Date 6/24/2027
Facility Type Physician Office
Lab Director GWENDOLYN A. DELANEY MD

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