11D2049293 CLIA NUMBER - NORTHSIDE CHEROKEE PEDIATRICS HOLLY SPRINGS

Laboratory Demographics

  • CLIA Code: 11D2049293
  • Facility Name: NORTHSIDE CHEROKEE PEDIATRICS HOLLY SPRINGS
  • Facility Address: 684 SIXES ROAD, SUITE 130
    HOLLY SPRINGS, GA
    ZIP 30115
  • Facility Phone: 678 388-5485
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MS. JAMIE H. ROLLINS
  • NPI Number: 1770112021
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 11D2049293
LAB Type Physician Office
Facility Name NORTHSIDE CHEROKEE PEDIATRICS HOLLY SPRINGS
Street 684 SIXES ROAD, SUITE 130
City HOLLY SPRINGS
State GA
ZIP 30115
Phone 678 388-5485
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/2/2024
Certificate Expiration Date 11/1/2026
Facility Type Physician Office
Lab Director MS. JAMIE H. ROLLINS

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