11D1049187 CLIA NUMBER - DEKALB PEDIATRIC ASSOCIATES PC

Laboratory Demographics

  • CLIA Code: 11D1049187
  • Facility Name: DEKALB PEDIATRIC ASSOCIATES PC
  • Facility Address: 1390 MONTREAL ROAD SUITE 180
    TUCKER, GA
    ZIP 30084
  • Facility Phone: 404 446-4600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RONALD A. HOMER
  • NPI Number: 1376829911
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D1049187
LAB Type Physician Office
Facility Name DEKALB PEDIATRIC ASSOCIATES PC
Street 1390 MONTREAL ROAD SUITE 180
City TUCKER
State GA
ZIP 30084
Phone 404 446-4600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/14/2025
Certificate Expiration Date 6/13/2027
Facility Type Physician Office
Lab Director RONALD A. HOMER

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