11D2139916 CLIA NUMBER - KIDS' - DOC - ON - WHEELS, INC

Laboratory Demographics

  • CLIA Code: 11D2139916
  • Facility Name: KIDS' - DOC - ON - WHEELS, INC
  • Facility Address: 4112 E PONCE DE LEON AVENUE, SUITE 2
    CLARKSTON, GA
    ZIP 30021
  • Facility Phone: 404 574-2512
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: LYNETTE WILSON-PHILLIPS
  • NPI Number: 1497277404
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D2139916
LAB Type Mobile Laboratory
Facility Name KIDS' - DOC - ON - WHEELS, INC
Street 4112 E PONCE DE LEON AVENUE, SUITE 2
City CLARKSTON
State GA
ZIP 30021
Phone 404 574-2512
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/13/2023
Certificate Expiration Date 11/12/2025
Facility Type Mobile Laboratory
Lab Director LYNETTE WILSON-PHILLIPS

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