11D1046154 CLIA NUMBER - EXCELLENT PEDIATRIC

Laboratory Demographics

CLIA Number: 11D1046154

Facility Name: EXCELLENT PEDIATRIC

Facility Address:
333 ALCOVY STREET, SUITE1
MONROE, GA
ZIP 30655
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Facility Phone Number: 678 807-2230

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1104141837

Taxonomy: 261QP2300X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	10/3/2023
CertificateExpirationDate	10/2/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024