11D2077893 CLIA NUMBER - GRAHAM PEDIATRICS OF WOODSTOCK

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Laboratory Demographics

CLIA Number: 11D2077893

Facility Name: GRAHAM PEDIATRICS OF WOODSTOCK

Facility Address:
105 MIRRAMONT LAKE DRIVE
WOODSTOCK, GA
ZIP 30189
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Facility Phone Number: 770 485-9670

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1316485717

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	11D2077893
LAB Type	Physician Office
Facility Name	GRAHAM PEDIATRICS OF WOODSTOCK
Street	105 MIRRAMONT LAKE DRIVE
City	WOODSTOCK
State	GA
ZIP	30189
Phone	770 485-9670
CertificateType	4
CertificateEffectiveDate	5/16/2024
CertificateExpirationDate	5/15/2026
FacilityType	Waiver

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