11D2134516 CLIA NUMBER - BRIARVISTA PEDIATRICS, LLC

Laboratory Demographics

CLIA Number: 11D2134516

Facility Name: BRIARVISTA PEDIATRICS, LLC

Facility Address:
2244 HENDERSON MILL ROAD, SUITE 108
ATLANTA, GA
ZIP 30345
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Facility Phone Number: 770 239-2500

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1871027839

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2134516
LAB Type	Physician Office
Facility Name	BRIARVISTA PEDIATRICS, LLC
Street	2244 HENDERSON MILL ROAD, SUITE 108
City	ATLANTA
State	GA
ZIP	30345
Phone	770 239-2500
CertificateType	4
CertificateEffectiveDate	8/4/2023
CertificateExpirationDate	8/3/2025
FacilityType	Waiver

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