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11D2027907 CLIA NUMBER - WOODSTOCK PEDIATRIC MEDICINE PC

Laboratory Demographics

CLIA Number: 11D2027907

Facility Name: WOODSTOCK PEDIATRIC MEDICINE PC

Facility Address:
2000 PROFESSIONAL WAY, BLDG 100, SUITE A
WOODSTOCK, GA
ZIP 30188
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Facility Phone Number: 770 517-0250

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1841402781

Taxonomy: 208000000X - Pediatrics
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

CLIA Record

Field Name Field Value
CLIA Number 11D2027907
LAB Type Physician Office
Facility Name WOODSTOCK PEDIATRIC MEDICINE PC
Street 2000 PROFESSIONAL WAY, BLDG 100, SUITE A
City WOODSTOCK
State GA
ZIP 30188
Phone 770 517-0250
CertificateType 4
CertificateEffectiveDate 8/4/2023
CertificateExpirationDate 8/3/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024