11D2008455 CLIA NUMBER - IVY LEAGUE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 11D2008455
  • Facility Name: IVY LEAGUE PEDIATRICS
  • Facility Address: 603 OLD NORCROSS ROAD, SUITE A
    LAWRENCEVILLE, GA
    ZIP 30046
  • Facility Phone: 678 407-4489
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NNEKA C. UNACHUKWU
  • NPI Number: 1386928943
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D2008455
LAB Type Physician Office
Facility Name IVY LEAGUE PEDIATRICS
Street 603 OLD NORCROSS ROAD, SUITE A
City LAWRENCEVILLE
State GA
ZIP 30046
Phone 678 407-4489
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/28/2025
Certificate Expiration Date 3/27/2027
Facility Type Physician Office
Lab Director NNEKA C. UNACHUKWU

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