11D1055197 CLIA NUMBER - KIDS CHOICE PEDICATRICS

Laboratory Demographics

CLIA Number: 11D1055197

Facility Name: KIDS CHOICE PEDICATRICS

Facility Address:
2775 CRUSE ROAD, SUITE 1801
LAWRENCEVILLE, GA
ZIP 30044
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Facility Phone Number: 678 380-9199

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1750509634

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D1055197
LAB Type	Physician Office
Facility Name	KIDS CHOICE PEDICATRICS
Street	2775 CRUSE ROAD, SUITE 1801
City	LAWRENCEVILLE
State	GA
ZIP	30044
Phone	678 380-9199
CertificateType	4
CertificateEffectiveDate	6/12/2022
CertificateExpirationDate	6/11/2024
FacilityType	Waiver

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