11D2103338 CLIA NUMBER - HUBBARD PEDIATRIC GROUP

Laboratory Demographics

  • CLIA Code: 11D2103338
  • Facility Name: HUBBARD PEDIATRIC GROUP
  • Facility Address: 4495 ATLANTA HWY STE 200
    LOGANVILLE, GA
    ZIP 30052
  • Facility Phone: 770 710-0117
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HOLLY L. HUBBARD
  • NPI Number: 1447660113
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D2103338
LAB Type Physician Office
Facility Name HUBBARD PEDIATRIC GROUP
Street 4495 ATLANTA HWY STE 200
City LOGANVILLE
State GA
ZIP 30052
Phone 770 710-0117
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/9/2023
Certificate Expiration Date 10/8/2025
Facility Type Physician Office
Lab Director HOLLY L. HUBBARD

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This page was last updated on: 6/4/2025