11D1056958 CLIA NUMBER - ABC PEDIATRIC GROUP PC

Laboratory Demographics

  • CLIA Code: 11D1056958
  • Facility Name: ABC PEDIATRIC GROUP PC
  • Facility Address: 2240 WEST PARK PLACE BOULEVARD SUITE A
    STONE MOUNTAIN, GA
    ZIP 30087
  • Facility Phone: 770 771-5222
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARCIA A. CUMBERBATCH MD
  • NPI Number: 1093729089
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D1056958
LAB Type Physician Office
Facility Name ABC PEDIATRIC GROUP PC
Street 2240 WEST PARK PLACE BOULEVARD SUITE A
City STONE MOUNTAIN
State GA
ZIP 30087
Phone 770 771-5222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/31/2024
Certificate Expiration Date 7/30/2026
Facility Type Physician Office
Lab Director MARCIA A. CUMBERBATCH MD

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