11D1043994 CLIA NUMBER - SPECTRUM PEDIATRIC GROUP

Laboratory Demographics

  • CLIA Code: 11D1043994
  • Facility Name: SPECTRUM PEDIATRIC GROUP
  • Facility Address: 3150 COBB PARKWAY, SUITE 130
    KENNESAW, GA
    ZIP 30152
  • Facility Phone: 770 966-0778
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KOLA OLOGUNJA
  • NPI Number: 1154447043
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1043994
LAB Type Physician Office
Facility Name SPECTRUM PEDIATRIC GROUP
Street 3150 COBB PARKWAY, SUITE 130
City KENNESAW
State GA
ZIP 30152
Phone 770 966-0778
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/9/2025
Certificate Expiration Date 8/8/2027
Facility Type Physician Office
Lab Director KOLA OLOGUNJA

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