11D1070144 CLIA NUMBER - PRINCETON LAKES PEDIATRICS

Laboratory Demographics

  • CLIA Code: 11D1070144
  • Facility Name: PRINCETON LAKES PEDIATRICS
  • Facility Address: 3885 PRICETON LAKES WAY SUITE 302
    ATLANTA, GA
    ZIP 30331
  • Facility Phone: 404 629-1880
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DEKISHA PENDERGRASS DRAYTON MD
  • NPI Number: 1518236645
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D1070144
LAB Type Physician Office
Facility Name PRINCETON LAKES PEDIATRICS
Street 3885 PRICETON LAKES WAY SUITE 302
City ATLANTA
State GA
ZIP 30331
Phone 404 629-1880
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/21/2025
Certificate Expiration Date 6/20/2027
Facility Type Physician Office
Lab Director DEKISHA PENDERGRASS DRAYTON MD

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