11D1055197 CLIA NUMBER - KIDS CHOICE PEDICATRICS

Laboratory Demographics

  • CLIA Code: 11D1055197
  • Facility Name: KIDS CHOICE PEDICATRICS
  • Facility Address: 2775 CRUSE ROAD, SUITE 1801
    LAWRENCEVILLE, GA
    ZIP 30044
  • Facility Phone: 678 380-9199
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: VENKATESWARA R. DIKKALA
  • NPI Number: 1750509634
  • Taxonomy: 261QP2300X - Clinic/Center

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/12/2024
Certificate Expiration Date 6/11/2026
Facility Type Physician Office
Lab Director VENKATESWARA R. DIKKALA

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