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11D2095101 CLIA NUMBER - PEDIATRIC EAR, NOSE & THROAT OF ATLANTA

Laboratory Demographics

CLIA Number: 11D2095101

Facility Name: PEDIATRIC EAR, NOSE & THROAT OF ATLANTA

Facility Address:
3300 OLD MILTON PKWY #275
ALPHARETTA, GA
ZIP 30005
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Facility Phone Number: 404 255-2033

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1134380017

Taxonomy: 207YP0228X - Otolaryngology
A pediatric otolaryngologist has special expertise in the management of infants and children with disorders that include congenital and acquired conditions involving the aerodigestive tract, nose and paranasal sinuses, the ear and other areas of the head and neck. The pediatric otolaryngologist has special skills in the diagnosis, treatment, and management of childhood disorders of voice, speech, language and hearing.

CLIA Record

Field Name Field Value
CLIA Number 11D2095101
LAB Type Physician Office
Facility Name PEDIATRIC EAR, NOSE & THROAT OF ATLANTA
Street 3300 OLD MILTON PKWY #275
City ALPHARETTA
State GA
ZIP 30005
Phone 404 255-2033
CertificateType 4
CertificateEffectiveDate 2/15/2023
CertificateExpirationDate 2/14/2025
FacilityType Waiver

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