11D1046154 CLIA NUMBER - EXCELLENT PEDIATRIC

Laboratory Demographics

  • CLIA Code: 11D1046154
  • Facility Name: EXCELLENT PEDIATRIC
  • Facility Address: 333 ALCOVY STREET, SUITE1
    MONROE, GA
    ZIP 30655
  • Facility Phone: 678 807-2230
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROGER L. MORALES
  • NPI Number: 1104141837
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1046154
LAB Type Physician Office
Facility Name EXCELLENT PEDIATRIC
Street 333 ALCOVY STREET, SUITE1
City MONROE
State GA
ZIP 30655
Phone 678 807-2230
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/3/2025
Certificate Expiration Date 10/2/2027
Facility Type Physician Office
Lab Director ROGER L. MORALES

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