11D2031384 CLIA NUMBER - DELTA PEDIATRICS, LLC

Laboratory Demographics

  • CLIA Code: 11D2031384
  • Facility Name: DELTA PEDIATRICS, LLC
  • Facility Address: 3966 SOUTH BOGAN ROAD, BUILDING B
    BUFORD, GA
    ZIP 30519
  • Facility Phone: 770 713-4646
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EMMANUEL E. MORDI
  • NPI Number: 1154605749
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D2031384
LAB Type Physician Office
Facility Name DELTA PEDIATRICS, LLC
Street 3966 SOUTH BOGAN ROAD, BUILDING B
City BUFORD
State GA
ZIP 30519
Phone 770 713-4646
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/19/2025
Certificate Expiration Date 10/18/2027
Facility Type Physician Office
Lab Director EMMANUEL E. MORDI

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