11D2047233 CLIA NUMBER - WELLSTAR MEADOW PEDIATRICS

Laboratory Demographics

  • CLIA Code: 11D2047233
  • Facility Name: WELLSTAR MEADOW PEDIATRICS
  • Facility Address: 10710 MEDLOCK BRIDGE ROAD, SUITE 250
    JOHNS CREEK, GA
    ZIP 30097
  • Facility Phone: 678 701-7718
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SRIDEVI MUTHUKUMAR
  • NPI Number: 1508031048
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D2047233
LAB Type Physician Office
Facility Name WELLSTAR MEADOW PEDIATRICS
Street 10710 MEDLOCK BRIDGE ROAD, SUITE 250
City JOHNS CREEK
State GA
ZIP 30097
Phone 678 701-7718
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/20/2024
Certificate Expiration Date 9/19/2026
Facility Type Physician Office
Lab Director SRIDEVI MUTHUKUMAR

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