11D2051267 CLIA NUMBER - VIBRANT KIDS PEDIATRICS, LLC

Laboratory Demographics

  • CLIA Code: 11D2051267
  • Facility Name: VIBRANT KIDS PEDIATRICS, LLC
  • Facility Address: 10 MARKET SQUARE WAY, SUITE 100
    NEWNAN, GA
    ZIP 30265
  • Facility Phone: 678 423-5560
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JILL B. DICKERSON
  • NPI Number: 1811241417
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2051267
LAB Type Physician Office
Facility Name VIBRANT KIDS PEDIATRICS, LLC
Street 10 MARKET SQUARE WAY, SUITE 100
City NEWNAN
State GA
ZIP 30265
Phone 678 423-5560
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2024
Certificate Expiration Date 12/16/2026
Facility Type Physician Office
Lab Director JILL B. DICKERSON

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