11D1055105 CLIA NUMBER - LUCAS PEDIATRICS

Laboratory Demographics

  • CLIA Code: 11D1055105
  • Facility Name: LUCAS PEDIATRICS
  • Facility Address: 595 EAST CROSSVILLE ROAD, SUITE 100
    ROSWELL, GA
    ZIP 30075
  • Facility Phone: 770 645-2250
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROBERTA LUCAS
  • NPI Number: 1093982746
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D1055105
LAB Type Physician Office
Facility Name LUCAS PEDIATRICS
Street 595 EAST CROSSVILLE ROAD, SUITE 100
City ROSWELL
State GA
ZIP 30075
Phone 770 645-2250
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/8/2024
Certificate Expiration Date 6/7/2026
Facility Type Physician Office
Lab Director ROBERTA LUCAS

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