11D2092475 CLIA NUMBER - SUMTER PEDIATRICS LLC

Laboratory Demographics

  • CLIA Code: 11D2092475
  • Facility Name: SUMTER PEDIATRICS LLC
  • Facility Address: 340 US HIGHWAY 19 S
    LEESBURG, GA
    ZIP 31763
  • Facility Phone: 229 924-8082
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NELSON T. MADRAZO
  • NPI Number: 1982756987
  • Taxonomy: 363LP0200X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 11D2092475
LAB Type Physician Office
Facility Name SUMTER PEDIATRICS LLC
Street 340 US HIGHWAY 19 S
City LEESBURG
State GA
ZIP 31763
Phone 229 924-8082
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/5/2025
Certificate Expiration Date 3/4/2027
Facility Type Physician Office
Lab Director NELSON T. MADRAZO

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