11D2008460 CLIA NUMBER - TRI COUNTY PEDIATRICS

Laboratory Demographics

  • CLIA Code: 11D2008460
  • Facility Name: TRI COUNTY PEDIATRICS
  • Facility Address: 1240 HIGHWAY 54 W, SUITE 100
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 770 996-9191
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUSHILA M. MATHEW
  • NPI Number: 1285859413
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D2008460
LAB Type Physician Office
Facility Name TRI COUNTY PEDIATRICS
Street 1240 HIGHWAY 54 W, SUITE 100
City FAYETTEVILLE
State GA
ZIP 30214
Phone 770 996-9191
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/10/2024
Certificate Expiration Date 6/9/2026
Facility Type Physician Office
Lab Director SUSHILA M. MATHEW

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