11D1053453 CLIA NUMBER - SUNNYSIDE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 11D1053453
  • Facility Name: SUNNYSIDE PEDIATRICS
  • Facility Address: 1661 W MCINTOSH ROAD
    GRIFFIN, GA
    ZIP 30223
  • Facility Phone: 770 233-4668
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHANDANA PRABHUDEV
  • NPI Number: 1275810780
  • Taxonomy: 208000000X - Pediatrics

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D1053453
LAB Type Physician Office
Facility Name SUNNYSIDE PEDIATRICS
Street 1661 W MCINTOSH ROAD
City GRIFFIN
State GA
ZIP 30223
Phone 770 233-4668
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/25/2024
Certificate Expiration Date 4/24/2026
Facility Type Physician Office
Lab Director CHANDANA PRABHUDEV

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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