11D2119083 CLIA NUMBER - GRAYSON PEDIATRICS, LLC

Laboratory Demographics

  • CLIA Code: 11D2119083
  • Facility Name: GRAYSON PEDIATRICS, LLC
  • Facility Address: 297 COOPER ROAD
    LOGANVILLE, GA
    ZIP 30052
  • Facility Phone: 678 381-2630
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JULIE A. OPEKA
  • NPI Number: 1831500370
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D2119083
LAB Type Physician Office
Facility Name GRAYSON PEDIATRICS, LLC
Street 297 COOPER ROAD
City LOGANVILLE
State GA
ZIP 30052
Phone 678 381-2630
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/20/2024
Certificate Expiration Date 9/19/2026
Facility Type Physician Office
Lab Director JULIE A. OPEKA

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