11D2118785 CLIA NUMBER - SUNFLOWER PEDIATRICS

Laboratory Demographics

CLIA Number: 11D2118785

Facility Name: SUNFLOWER PEDIATRICS

Facility Address:
5422 HIGHWAY 20 SUITE 203
SUGAR HILL, GA
ZIP 30518
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Facility Phone Number: 404 580-8022

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1003269002

Taxonomy: 363LP0200X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	11D2118785
LAB Type	Physician Office
Facility Name	SUNFLOWER PEDIATRICS
Street	5422 HIGHWAY 20 SUITE 203
City	SUGAR HILL
State	GA
ZIP	30518
Phone	404 580-8022
CertificateType	4
CertificateEffectiveDate	9/14/2022
CertificateExpirationDate	9/13/2024
FacilityType	Waiver

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